Individual
DR. MICHAEL BRYAN MISKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
612 13TH ST S, VIRGINIA, MN 55792-3149
(218) 741-0405
(218) 741-1445
Mailing address
612-13TH. ST. SO., VIRGINIA, MN 55792
(218) 741-0405
(218) 741-1445
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12649
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D12649
DENTAL LICENSE
MN
Enumeration date
06/05/2009
Last updated
06/05/2009
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