Healthcare Provider Details

I. General information

NPI: 1649215328
Provider Name (Legal Business Name): JOEL C MICHELSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 10TH LN NW
ROCHESTER MN
55901-6917
US

IV. Provider business mailing address

605 HILLCREST AVE SUITE 130
OWATONNA MN
55060-3680
US

V. Phone/Fax

Practice location:
  • Phone: 507-281-5000
  • Fax: 507-281-5001
Mailing address:
  • Phone: 507-451-0290
  • Fax: 507-451-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD10189
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: