Provider Demographics
NPI:1447468947
Name:MISISCHIA, ARTHUR JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:JOSEPH
Last Name:MISISCHIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:220 LADUE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7452
Mailing Address - Country:US
Mailing Address - Phone:314-330-6071
Mailing Address - Fax:
Practice Address - Street 1:2800 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4742
Practice Address - Country:US
Practice Address - Phone:618-474-7208
Practice Address - Fax:618-474-7124
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0129941223S0112X
IL0190240401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery