Individual
DR. BRUCE A MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
976 3 MILE RD NW, GRAND RAPIDS, MI 49544
(616) 784-4038
(616) 785-9501
Mailing address
976 3 MILE RD NW, GRAND RAPIDS, MI 49544
(616) 784-4038
(616) 785-9501
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11496
MI
Other
Enumeration date
11/16/2006
Last updated
07/08/2007
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