Individual
JUSTIN MIKESELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1315 E 24TH ST STE 1, MINNEAPOLIS, MN 55404-3959
(612) 721-9800
(612) 721-7870
Mailing address
1315 E 24TH ST STE 1, MINNEAPOLIS, MN 55404-3959
(612) 721-9800
(612) 721-7870
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D14826
MN
1223G0001X
General Practice Dentistry
DS041719
PA
Other
Enumeration date
06/25/2018
Last updated
10/05/2022
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