Individual
MARY E. MIKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3838 W 111TH ST STE 105, CHICAGO, IL 60655-4042
(773) 233-6300
Mailing address
3838 W 111TH ST STE 105, CHICAGO, IL 60655-4042
(773) 233-6300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019019681
IL
Other
Enumeration date
07/11/2011
Last updated
07/11/2011
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