Mickelwait Family Dentistry PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

DE60070169 Issued in WA

Legal business name

MICKELWAIT FAMILY DENTISTRY PLLC

Practice address

1420 Roosevelt Ave
Ste 7
Mount Vernon, WA 98273-2687

Phone

(360) 424-3450

Fax

(360) 428-0927

NPI assigned

Sep 8, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Joel S Mickelwait, D.D.S.

Title

Member

Phone

(360) 424-3450

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252368000000",
    "number": "1568795649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 ROOSEVELT AVE",
            "address_2": "STE 7",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732687",
            "telephone_number": "360-424-3450",
            "fax_number": "360-428-0927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 ROOSEVELT AVE",
            "address_2": "STE 7",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732687",
            "telephone_number": "360-424-3450",
            "fax_number": "360-428-0927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICKELWAIT FAMILY DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2009-09-08",
        "status": "A",
        "authorized_official_last_name": "MICKELWAIT",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "360-424-3450",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60070169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Michelle Mestrich, RN
• Anita Marie Meyer, MD
• Erin Meyer, RN
• James Lloyd Meyers, B.A.
• Michele K. Coleman DO & Associates, Inc.
• J Semmes Mickelwait, MD
• Morghan B Milagrosa, CNM, ANP
• Denise Lee Miller
• Jacob Darris Miller, B.A.
• Jeffrey Wells Miller, MD

• Dentist in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2009; 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.