Organization
MICKELSON-GATES DENTISTRY PLLC
Active
Other names
North Idaho Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
AMY WINTER (OFFICE MANAGER)
(208) 667-8282
Entity
Organization
Contact information
Practice address
2165 N MERRITT CREEK, COEUR D ALENE, ID 83814-8381
(208) 667-8282
Mailing address
2165 N MERRITT CREEK LOOP, COEUR D ALENE, ID 83814-4949
(208) 667-8282
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223D0001X
Public Health Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184035115
CHACE MICKELSON
—
Enumeration date
01/14/2020
Last updated
02/03/2021
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