Peter J Miskovich, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11951 Issued in MN

Practice address

1121 SE 4TH Avenue
Grand Rapids, MN 55744

Phone

(218) 326-3437

Fax

(218) 327-1211

NPI assigned

Nov 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Miskovich Dental Clinic

  • General Practice Dentistry
  • Grand Rapids, MN
  • NPI 1255407060
  NPD (past) Authorized official
• Northern Dental Partners and Associates PLLC

  dba Miskovich Dental Clinic

  • General Practice Dentistry
  • Grand Rapids, MN
  • NPI 1396497434
  NPD (past) Authorized official

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780759944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 SE 4TH AVENUE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "55744",
            "telephone_number": "218-326-3437",
            "fax_number": "218-327-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 SE 4TH AVENUE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "55744",
            "telephone_number": "218-326-3437",
            "fax_number": "218-327-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISKOVICH",
        "first_name": "PETER",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1670908",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND SH OF MN",
            "identifier": "275L7MI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "D11951",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Flood Miley, LMFT
• John Samuel Miller, LADC
• Martha Miltich
• Miskovich Dental Clinic
• Mike N Miskovich, DDS
• Mission Restart Inc.
• Kendra Beth Mitchell, PHARMD
• Lorna Mix
• Modern Mojo
• Audrey Moen

• General Practice Dentistry in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.