Central Oregon Perio

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D7709 Issued in OR

Legal business name

CENTRAL OREGON PERIO

Practice address

1569 SW Nancy Way Ste 3
Bend, OR 97702

Phone

(541) 317-0255

Fax

(541) 317-0355

NPI assigned

Nov 28, 2006

Last updated

Jul 9, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas W Misischia, DMDNPI 1215249685

Title

President

Phone

(541) 317-0255

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicholas W. Misischia, DMD

  • Periodontics
  • Bend, OR
  • NPI 1215249685
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1336216373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1569 SW NANCY WAY",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023234",
            "telephone_number": "541-317-0255",
            "fax_number": "541-317-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1569 SW NANCY WAY STE 3",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "541-317-0255",
            "fax_number": "541-317-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OREGON PERIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "MISISCHIA",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-317-0255",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D7709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central Oregon Magnetic Resonance Imaging LLC
• Central Oregon Mobile Phlebotomy Services, LLC
• Central Oregon Pathology Consultants, PC
• Central Oregon Pediatric Associates
• Central Oregon Pediatric Associates Subspecialty
• Central Oregon Pharmacy Enterprises (Tumalo Pharmacy)
• Central Oregon Radiology Assoc PC
• Central Oregon Radiology Assoc., P.C. (CORA Vascular Interventional Specialists)
• Central Oregon Regional Pathology Services, LLC
• Central Oregon Sleep Disorders Center,LLC

• Periodontics in Bend, OR
• Providers in Bend, OR by specialty
• Periodontics in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.