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General NPI Number Information
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NPI Number | 1760897714
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Entity Type | Individual
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Provider Name | ALICIA JAMELLE MICKLES D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2014
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 6140 UNIVERSITY DR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35806-1772
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Country | US
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Telephone | 256-285-3420
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Fax |
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Provider Business Mailing Address
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Address Line | 6140 UNIVERSITY DR NW
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City | HUNTSVILLE
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State | AL
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Zip | 35806-1772
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Country | US
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Telephone | 256-285-3420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.025418
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D.007173-C
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11769
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10030
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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