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Individual

THOR L MIKESELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
408 ST JOSEPH ST, SUTTONS BAY, MI 49682
(231) 271-3315
(231) 271-3317
Mailing address
PO BOX 759, SUTTONS BAY, MI 49682-0759
(231) 271-3315
(231) 271-3317

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901017254
MI

Other

Enumeration date
01/10/2006
Last updated
09/11/2007
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