Individual
MR. MIKE N MISKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1121 SE 4TH AVENUE, GRAND RAPIDS, MN 55744
(218) 326-3437
(218) 327-1211
Mailing address
1121 SE 4TH AVENUE, GRAND RAPIDS, MN 55744
(218) 326-3437
(218) 327-1211
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8313
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72417MI
BLUE CROSS BLUE SH MN
MN
01
—
85154
UNITED CONCORDIA
—
Enumeration date
11/22/2006
Last updated
07/08/2007
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