Individual
DR. QUINN COOPER MIKESELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
711 RIGBY LAKE DR. #102, RIGBY, ID 83442
(208) 745-8788
(208) 745-6104
Mailing address
711 RIGBY LAKE DR. #102, RIGBY, ID 83442
(208) 745-8788
(208) 745-6104
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3876
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807203400
—
ID
Enumeration date
08/02/2006
Last updated
11/25/2015
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