DR. Chace Derrick Mickelson, D.M.D
NPI #1184035115 in Coeur D Alene, Idaho
Provider Information
- NPI Number
- 1184035115
- Entity Type
- Individual
- Name
- DR. Chace Derrick Mickelson, D.M.D
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Dentist
- Credential
- D.M.D
- Enumeration Date
- May 13, 2014
- Last Updated
- Aug 17, 2020
Practice Location
- Address
- 1090 W PARK PL
- Address 2
- SUITE B
- City
- Coeur D Alene
- State
- Idaho
- ZIP Code
- 83814-2785
- Phone
- (208) 292-0303
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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