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Organization
NICHOLAS MICKELSON LLC
Active
Organization
NICHOLAS MICKELSON LLC
Active
Other names
Nova Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAISA BICUDO MICKELSON (OFFICE MANAGER)
(813) 616-9019
Entity
Organization
Contact information
Practice address
13612 W HILLSBOROUGH AVE, TAMPA, FL 33635-9638
(813) 444-7502
Mailing address
8805 RUSTIC TRAIL CT, TAMPA, FL 33635-1557
(813) 616-9019
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/01/2020
Last updated
12/01/2020
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