Bonnie Misiak, DDS

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

DN16641 Issued in FL

Practice address

115 K D Revell Rd
Wauchula, FL 33873-2051

Phone

(863) 773-4161

NPI assigned

Sep 1, 2006

Last updated

Mar 7, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362614400000",
    "number": "1699877860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 K D REVELL RD",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338732051",
            "telephone_number": "863-773-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 K D REVELL RD",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338732051",
            "telephone_number": "863-773-4161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISIAK",
        "first_name": "BONNIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2013-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "FL",
            "license": "DN16641",
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "FL",
            "license": "DH17043",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027924211",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DDS LICENSE",
            "identifier": "DN16641",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DH LICENSE",
            "identifier": "DH17043",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Public Health Dentistry in Wauchula, FL
• Providers in Wauchula, FL by specialty
• Public Health Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.