Individual
DR. C JAMES MIKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3308 KIMBALL AVE, WATERLOO, IA 50702
(319) 233-6177
(319) 234-3906
Mailing address
3308 KIMBALL AVE, WATERLOO, IA 50702
(319) 233-6177
(319) 234-3906
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
05851
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120865
—
IA
Enumeration date
08/12/2006
Last updated
07/08/2007
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