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Organization

NICHOLAS MICKELSON LLC

Active
Other names
Nova Dental
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MAISA BICUDO MICKELSON (OFFICE MANAGER)
(813) 616-9019
Entity
Organization

Contact information

Practice address
13612 W HILLSBOROUGH AVE, TAMPA, FL 33635-9638
(813) 444-7502
Mailing address
8805 RUSTIC TRAIL CT, TAMPA, FL 33635-1557
(813) 616-9019

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
12/01/2020
Last updated
12/01/2020
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