Justin Mikesell, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14826 Issued in MN

Practice address

1315 E 24TH St Ste 1
Minneapolis, MN 55404-3959

Phone

(612) 721-9800

Fax

(612) 721-7870

NPI assigned

Jun 25, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jmikesell670374@direct.ochin.org
• Direct secure messaging: justin.mikesell.p12@direct.cornerstonecare.nextgenshare.com

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.

• Indian Health Board of Minneapolis, Inc

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1811999162
  Medicare reassignment
• Merit Dental Inc.

  • General Practice Dentistry
  • Manchester, PA
  • NPI 1508109117
  NPD (past)
• Wheatlyn Dental Practice, LLP

  • General Practice Dentistry
  • Manchester, PA
  • NPI 1932253564
  NPD (past)

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1831684539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 E 24TH ST STE 1",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043959",
            "telephone_number": "612-721-9800",
            "fax_number": "612-721-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 E 24TH ST STE 1",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043959",
            "telephone_number": "612-721-9800",
            "fax_number": "612-721-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKESELL",
        "first_name": "JUSTIN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-25",
        "last_updated": "2022-10-05",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS041719",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Migana Home Healthcare, LLC
• Mighty Massage Inc
• Carla M Miguel
• Elizabeth Bester Mihalchick, LPCC, LADC, LSC
• Christina Lee Mikesell, D.O.
• Sherief A Mikhail, M.D.,M.P.H.
• Savanna Joy Mikkalson, DDS
• Erik Mikkelsen, M.D.
• Jessica Mikkelson, OTD, OTR/L
• Michael Gerard Mikkelson, PTA

• Dentist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.

Verify at the official NPI Registry.