Individual
DR. JOHN EDWARD MICELI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
9984 MARTIN AVE, LAKE CITY, PA 16423-1527
(814) 774-5242
(814) 774-5242
Mailing address
944 AURORA AVE, GIRARD, PA 16417-1246
(814) 774-1498
(814) 774-5242
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12971
MD
1223G0001X
General Practice Dentistry
30.021870
OH
1223G0001X
General Practice Dentistry
Primary
DS-030548-L
PA
Other
Enumeration date
10/31/2006
Last updated
07/08/2007
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