# MICKELWAIT FAMILY DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568795649
- **Authorized official:** MR. JOEL S MICKELWAIT D.D.S. (MEMBER)
- **Authorized official phone:** (360) 424-3450

## Contact information

- **Practice address:** 1420 ROOSEVELT AVE, STE 7, MOUNT VERNON, WA 98273-2687
- **Practice address phone:** (360) 424-3450
- **Practice address fax:** (360) 428-0927
- **Mailing address:** 1420 ROOSEVELT AVE, STE 7, MOUNT VERNON, WA 98273-2687
- **Mailing address phone:** (360) 424-3450
- **Mailing address fax:** (360) 428-0927

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE60070169 | WA | Yes |

## Other

- **Enumeration date:** 09/08/2009
- **Last updated:** 09/08/2009