William Patrick Misischia, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

9827 Issued in CO

Practice address

350 Broadway St Ste 130
Boulder, CO 80305-3396

Phone

(034) 490-4103

Fax

(303) 449-0470

NPI assigned

Aug 2, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

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.

• Paul L Glick, DDS, Ms

  • Periodontics
  • Littleton, CO
  • NPI 1376686980
  NPD (past)

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1942588397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 BROADWAY ST STE 130",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803053396",
            "telephone_number": "034-490-4103",
            "fax_number": "303-449-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 BROADWAY ST STE 130",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803053396",
            "telephone_number": "034-490-4103",
            "fax_number": "303-449-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISISCHIA",
        "first_name": "WILLIAM",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-02",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "9827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas A Minor, M.D.
• Justine Nicole Miracle
• Donald A. Misch, M.D.
• Kalyani Mishra, MASTER OF PHILOSOPHY
• Andrew V Misiorowski, PT, DPT
• Mitchell a Baris, PH D, PC
• Mitchell Schroeder LLC
• Anna Rebecca Mitchell, PT
• Deanne Mitchell, R. PH.
• Jill Mitchell, LCSW

• All providers in Boulder, CO
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; 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.