Michael J Misencik, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

018257 Issued in OH

Practice address

109 Harris Road
Lodi, OH 44254

Phone

(330) 302-4005

NPI assigned

Mar 25, 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

Enrolled in OH

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)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1902048754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 CANYON VIEW RD",
            "city": "SAGAMORE HILLS",
            "state": "OH",
            "postal_code": "44067",
            "telephone_number": "216-688-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 HARRIS ROAD",
            "city": "LODI",
            "state": "OH",
            "postal_code": "44254",
            "telephone_number": "330-302-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISENCIK",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-25",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "018257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0666097",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabrina Rose Mangin
• Brianna Marie Manik
• Shannon McDonald
• Roselean Renee McDowell, PHARMD
• John Ignatius Meilinger, D.D.S.
• Erik Joseph Modlo, M.D.
• Charlene Marie Nagel, NP-C
• NP Wellness Care, LLC
• Sarah J Olenik, LSW, MSW, LICDC
• Gabrielle Paoletta, PT

• All providers in Lodi, OH
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.