J Ryan Mickelson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8630 Issued in CO

Practice address

2530 Colorado Ave
Suite 1a
Durango, CO 81301-4760

Phone

(970) 247-0174

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 2, 2016 through Jun 2, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Four Corners Smiles 4 Kids, Inc.

  • General Practice Dentistry
  • Durango, CO
  • NPI 1225364607
  NPD (past) Authorized official
• J Ryan Mickelson DDS, Inc.

  • General Practice Dentistry
  • Durango, CO
  • NPI 1437438389
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1346351624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 COLORADO AVE",
            "address_2": "SUITE 1A",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014760",
            "telephone_number": "970-247-0174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 COLORADO AVE",
            "address_2": "SUITE 1A",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014760",
            "telephone_number": "970-247-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "J",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8630",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4547",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD3644",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Meyer, ATC
• Eric Campbell Meyer, M.D.
• Deborah Brill Meyers, MS NP
• Mia Carrasco-Songer LCSW, LLC
• Whitney Mick, APN
• Milestones Pediatric Therapy, LLC
• Brian P Miller
• Douglas Eugene Miller, PSY.D.
• Eugenia M Miller, M.D.
• Jennifer Miller, MSN, RN, CARN

• General Practice Dentistry in Durango, CO
• Providers in Durango, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.