Michael Bryan Miskovich, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12649 Issued in MN

Practice address

612 13TH St S
Virginia, MN 55792-3149

Phone

(218) 741-0405

Fax

(218) 741-1445

NPI assigned

Jun 5, 2009

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Virginia-Gilbert Family Dental P.a

  • General Practice Dentistry
  • Virginia, MN
  • NPI 1518295567
  NPD (past)

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

{
    "created_epoch": "1244160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244160000000",
    "number": "1841426756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612-13TH. ST. SO.",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "55792",
            "telephone_number": "218-741-0405",
            "fax_number": "218-741-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 13TH ST S",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557923149",
            "telephone_number": "218-741-0405",
            "fax_number": "218-741-1445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISKOVICH",
        "first_name": "MICHAEL",
        "middle_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-05",
        "last_updated": "2009-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "D12649",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mesabi Eyewear, Inc.
• Mesabi Family Young Men'S Christian Association
• Midwest Vision Centers Inc
• Carol S Miettunen, RN
• Melissa Marie Milkovich, N.P.
• Emlynn Mock
• Debbie R Monacelli, PT
• Kaitlynn O Moore
• Jennifer Ann Moreland, LMFT
• Kristine Mosher, RN, CNP

• General Practice Dentistry in Virginia, MN
• Providers in Virginia, 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 Jun 5, 2009; 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.