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Organization
MICKELWAIT FAMILY DENTISTRY PLLC
Active
Organization
MICKELWAIT FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOEL S MICKELWAIT D.D.S. (MEMBER)
(360) 424-3450
Entity
Organization
Contact information
Practice address
1420 ROOSEVELT AVE, STE 7, MOUNT VERNON, WA 98273-2687
(360) 424-3450
(360) 428-0927
Mailing address
1420 ROOSEVELT AVE, STE 7, MOUNT VERNON, WA 98273-2687
(360) 424-3450
(360) 428-0927
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE60070169
WA
Other
Enumeration date
09/08/2009
Last updated
09/08/2009
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