Individual
DR. J RYAN MICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2530 COLORADO AVE, SUITE 1A, DURANGO, CO 81301-4760
(970) 247-0174
Mailing address
2530 COLORADO AVE, SUITE 1A, DURANGO, CO 81301-4760
(970) 247-0174
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8630
CO
1223G0001X
General Practice Dentistry
D-4547
ID
1223G0001X
General Practice Dentistry
DD3644
NM
Other
Enumeration date
08/31/2006
Last updated
02/15/2024
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