Individual
KENNETH W MICKENS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3400 PENROSE PL, SUITE 101, BOULDER, CO 80301-1809
(303) 442-8700
(303) 442-1326
Mailing address
3400 PENROSE PL, SUITE 101, BOULDER, CO 80301-1809
(303) 442-8700
(303) 442-1326
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7244
CO
Other
Enumeration date
06/30/2009
Last updated
06/30/2009
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