Provider Demographics
NPI:1871782722
Name:MISIUK, MAGDALENA J (DDS)
Entity type:Individual
Prefix:DR
First Name:MAGDALENA
Middle Name:J
Last Name:MISIUK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3050
Mailing Address - Country:US
Mailing Address - Phone:269-343-6533
Mailing Address - Fax:269-327-0406
Practice Address - Street 1:6016 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3050
Practice Address - Country:US
Practice Address - Phone:269-343-6533
Practice Address - Fax:269-327-0406
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010196551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice