# MICKELSON-GATES DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** North Idaho Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811537251
- **Authorized official:** AMY WINTER (OFFICE MANAGER)
- **Authorized official phone:** (208) 667-8282

## Contact information

- **Practice address:** 2165 N MERRITT CREEK, COEUR D ALENE, ID 83814-8381
- **Practice address phone:** (208) 667-8282
- **Mailing address:** 2165 N MERRITT CREEK LOOP, COEUR D ALENE, ID 83814-4949
- **Mailing address phone:** (208) 667-8282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 1223D0001X | Public Health Dentistry | — | — | — |

## Other

- **Enumeration date:** 01/14/2020
- **Last updated:** 02/03/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1184035115 | CHACE MICKELSON | — |