Individual
KYRA MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
4192 6TH ST APT 4, FORT WAINWRIGHT, AK 99703-1260
(928) 679-5898
Mailing address
4192 6TH ST APT 4, FORT WAINWRIGHT, AK 99703-1260
(928) 679-5898
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
147040
AK
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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