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NPI Code Detail

MEDICARE: DR. JOEL SEMMES MICKELWAIT DDS

MEDICARE: DR. JOEL SEMMES MICKELWAIT DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist57755CA

General Provider Information

NPI Number : 1851536874
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOEL SEMMES MICKELWAIT DDS
Provider Business Mailing Address
First Line : 969 TALCEY TERRACE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506
Country : US
Telephone Number : 951-533-9334
Fax Number :
Provider Business Practice Location Address
First Line : 311 WINSTON ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90013-1519
Country : US
Telephone Number : 213-839-1960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2008
Last Update Date : 12/04/2008

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