Individual
DR. JESS W MIKESELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1024 JONAS AVE, CENTRALIA, IL 62801
(618) 533-2107
Mailing address
1024 JONAS AVE, CENTRALIA, IL 62801
(618) 533-2107
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
014683
MO
122300000X
Dentist
—
IL
1223G0001X
General Practice Dentistry
Primary
319 009068 019019675
IL
Other
Enumeration date
04/03/2007
Last updated
09/11/2025
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