Individual
DR. PRENARD RAINEY MICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1416 YANCEYVILLE ST, SUITE 2, GREENSBORO, NC 27405-6955
(917) 805-8509
Mailing address
300 W 135TH ST APT 7D, NEW YORK, NY 10030-2760
(212) 234-6978
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
7637
NC
Other
Enumeration date
10/23/2007
Last updated
10/23/2007
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