J Ryan Mickelson DDS, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8630 Issued in CO

Legal business name

J RYAN MICKELSON DDS, INC.

Doing business as

Riverview Dental

Practice address

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

Phone

(970) 247-0174

Fax

(970) 382-2574

NPI assigned

Aug 10, 2011

Last updated

Aug 10, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Summer Peery

Title

Office Manager

Phone

(970) 247-0174

Specialties & licenses 1

Addresses

Other names 1

• Riverview Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• J Ryan Mickelson, D.D.S.

  • General Practice Dentistry
  • Durango, CO
  • NPI 1346351624
  NPD (past)

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312934400000",
    "number": "1437438389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 COLORADO AVE",
            "address_2": "STE 1A",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014760",
            "telephone_number": "970-247-0174",
            "fax_number": "970-382-2574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 COLORADO AVE",
            "address_2": "STE 1A",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813014760",
            "telephone_number": "970-247-0174",
            "fax_number": "970-382-2574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J RYAN MICKELSON DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-10",
        "last_updated": "2011-08-10",
        "status": "A",
        "authorized_official_last_name": "PEERY",
        "authorized_official_first_name": "SUMMER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "970-247-0174",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverview Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew Louis Iorio, MD
• James Irish, MD
• Alexis Gazak Isaacs, NNP
• Ingrid Lyn Iversen, RPT
• Alexandria Ivery, RBT
• Lorielle M Jack
• Robin Oma Jackman, O.D.
• Alison W Jackson, M.D.
• Danette Jackson, RN
• David Christopher Jackson, D.C.

• 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 Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.