Blake Charles Mikesell, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901601410 Issued in MI

Practice address

1955 N Pontiac TRL
Walled Lake, MI 48390-3157

Phone

(248) 669-2311

NPI assigned

Aug 1, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Jamie L Hafke DDS PLLC

  • General Practice Dentistry
  • Walled Lake, MI
  • NPI 1255948790
  NPD

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1689300659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9639 CURRIE RD",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481679143",
            "telephone_number": "231-360-7138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1955 N PONTIAC TRL",
            "city": "WALLED LAKE",
            "state": "MI",
            "postal_code": "483903157",
            "telephone_number": "248-669-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKESELL",
        "first_name": "BLAKE",
        "middle_name": "CHARLES",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901601410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Taylor Metz, M.S., CCC-SLP
• Michael P McNutt D.D.S., P.C.
• Julie Marie Micheli, PA C
• Michigan Institute of Advanced Dentistry P C
• Midwest Medical Transportation, LLC.
• Christie Y Miller, FNP
• Tyrone S Miller, O.D.
• Ronald Mishko II, D.D.S.
• Mohammad Navai
• Zahra H Moshref, APN

• Dentist in Walled Lake, MI
• Providers in Walled Lake, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; 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.