Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1002078 | WI |
NPI | 1003475203 |
---|---|
Provider Name | Dr. Nicholas Miskulin |
First Address | Stetsonville, WI 54480-9721 |
Second Address | Eau Claire, WI 54701-6223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2019 |
Last Update Date | 11/06/2019 |