Provider Demographics
NPI:1619864360
Name:MISIEWICZ, SAVANNAH (DMD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:MISIEWICZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E TWIGGS ST UNIT 1213
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3180
Mailing Address - Country:US
Mailing Address - Phone:304-283-2474
Mailing Address - Fax:
Practice Address - Street 1:13584 UNIVERSITY PLAZA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4628
Practice Address - Country:US
Practice Address - Phone:813-971-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist