Individual
DR. BONNIE MISIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
115 K D REVELL RD, WAUCHULA, FL 33873-2051
(863) 773-4161
Mailing address
115 K D REVELL RD, WAUCHULA, FL 33873-2051
(863) 773-4161
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DN16641
FL
124Q00000X
Dental Hygienist
DH17043
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027924211
—
FL
01
—
DH17043
DH LICENSE
FL
01
—
DN16641
DDS LICENSE
FL
Enumeration date
09/01/2006
Last updated
03/07/2013
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