Healthcare Provider Details

I. General information

NPI: 1760577852
Provider Name (Legal Business Name): GERALD T MIKEL FAMILY DENTISTRY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 TOWER AVENUE
SUPERIOR WI
54880
US

IV. Provider business mailing address

3312 TOWER AVE
SUPERIOR WI
54880-5302
US

V. Phone/Fax

Practice location:
  • Phone: 715-392-1132
  • Fax: 715-392-2333
Mailing address:
  • Phone: 715-392-1132
  • Fax: 715-392-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD T MIKEL
Title or Position: DENTIST OWNER
Credential: DDS
Phone: 715-392-1132