Mickelwait Family Dentistry Pllc

NPI #1568795649 in Mount Vernon, Washington

Provider Information

NPI Number: 1568795649
Entity Type: Organization
Organization Name: Mickelwait Family Dentistry Pllc
Primary Specialty: Dentist
Enumeration Date: Sep 8, 2009
Last Updated: Sep 8, 2009

Practice Location

Address: 1420 ROOSEVELT AVE
Address 2: STE 7
City: Mount Vernon
State: Washington
ZIP Code: 98273-2687
Phone: (360) 424-3450

Authorized Official

Name: MR. JOEL S MICKELWAIT, D.D.S.
Title: MEMBER
Phone: (360) 424-3450

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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