Active NPI
Frank Mikkelsen, DDS
- Dentist
- Sonora, CA
National Provider Identifier
1700907946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30435
- Practice address
- 19060 Standard Rd
Suite 4
Sonora, CA 95370-7542 - Phone
- (209) 532-4607
- Fax
- (209) 533-5487
- NPI assigned
- Apr 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30435 | CA | Primary |
Addresses
Primary practice location
19060 Standard Rd
Suite 4
Sonora, CA 95370-7542
Mailing address
19060 Standard Rd
Suite 4
Sonora, CA 95370-7542
Phone (209) 532-4607
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160205000869 | CA | Order and Referring Only - Other (Non-Physician) | 3375847718 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700907946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19060 STANDARD RD",
"address_2": "SUITE 4",
"city": "SONORA",
"state": "CA",
"postal_code": "953707542",
"telephone_number": "209-532-4607",
"fax_number": "209-533-5487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19060 STANDARD RD",
"address_2": "SUITE 4",
"city": "SONORA",
"state": "CA",
"postal_code": "953707542",
"telephone_number": "209-532-4607",
"fax_number": "209-533-5487"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKKELSEN",
"first_name": "FRANK",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "30435",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sonora, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.