Individual
BLAKE CHARLES MIKESELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1955 N PONTIAC TRL, WALLED LAKE, MI 48390-3157
(248) 669-2311
Mailing address
9639 CURRIE RD, NORTHVILLE, MI 48167-9143
(231) 360-7138
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901601410
MI
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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