Individual
DR. JOHN S MICELI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
306 MAIN ST, WILMINGTON, MA 01887-2725
(978) 491-8847
Mailing address
PO BOX 7116, GLOUCESTER, MA 01930-5816
(978) 491-8847
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11925
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0202282
—
MA
Enumeration date
10/02/2006
Last updated
09/04/2015
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