Dr. CHACE DERRICK MICKELSON -- D.M.D
Individual Provider (NPI-1)
Active
Dentist
Provider Information
- NPI Number
1184035115- Provider Type
- Individual Provider (NPI-1)
- Credentials
- D.M.D
- Status
- Active
Contact & Location
- Address
- 1090 W PARK PL SUITE B, COEUR D ALENE, ID, 838142785
- Phone
- (208) 292-0303
Specialties & Taxonomies
Dentist
License: TX #29854
Dentist
Primary License: ID #D-4605