Individual
DR. LEO V. MIKESELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
HWY 191 HOSPITAL ROAD, CHINLE, AZ 86503
(928) 674-7001
(928) 674-7705
Mailing address
PO DRAWER PH, CHINLE, AZ 86503
(928) 674-7001
(928) 674-7705
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
133643-9923
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
824624
—
AZ
Enumeration date
04/04/2007
Last updated
07/09/2007
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