Mickelson-Gates Dentistry PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MICKELSON-GATES DENTISTRY PLLC

Doing business as

North Idaho Dental Group

Practice address

2165 N Merritt Creek
Coeur D Alene, ID 83814-8381

Phone

(208) 667-8282

NPI assigned

Jan 14, 2020

Organization subpart

No

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

Authorized official

Name

Amy Winter

Title

Office Manager

Phone

(208) 667-8282

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• North Idaho Dental Group Doing business as

Electronic endpoints 1

Practitioners 2

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.

• James Lee Landers, DDS

  • General Practice Dentistry
  • Coeur d'Alene, ID
  • NPI 1629143748
  NPD (past)
• Miranda Lynn Weber, DDS

  • Dentist
  • Post Falls, ID
  • NPI 1831884436
  NPD (past)

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1811537251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2165 N MERRITT CREEK LOOP",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144949",
            "telephone_number": "208-667-8282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2165 N MERRITT CREEK",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838148381",
            "telephone_number": "208-667-8282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30336 Highway 200 Ste A",
            "address_purpose": "LOCATION",
            "city": "Ponderay",
            "state": "ID",
            "postal_code": "838529775",
            "country_code": "US",
            "telephone_number": "082-667-8282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2165 N Merritt Creek Loop",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838144949",
            "country_code": "US",
            "telephone_number": "208-667-8282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICKELSON-GATES DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-14",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "WINTER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-667-8282"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHACE MICKELSON",
            "identifier": "1184035115",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Ponderay",
            "affiliation": "N",
            "address_1": "30336 Highway 200 Ste A",
            "city": "Ponderay",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838529775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "North Idaho Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Idaho Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Meza Post Acute and Long Term Care, PLLC
• Michael G Meza, MD
• Arne E Michalson, MD
• Linda S Michalson, MD
• Pablo Fernando Michel Sanchez, M.D.
• Chace Derrick Mickelson, D.M.D
• Midlife Center
• Brendan A Mielke, MD
• Mike Dusbabek Physical Therapy, PLLC
• Erika M Mikles, PA-C

• Dentist in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.