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Chace Mickelson, D.M.D — NPI 1184035115, Coeur D Alene, ID | NPI Central

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NPI 1184035115

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Chace Mickelson, D.M.D

NPI 1184035115 · Dentist · Coeur D Alene, ID

Provider details

NPI number: 1184035115
Entity type: Individual
Primary specialty: DentistDental Providers
Credential: D.M.D
Sex: Male
Sole proprietor: No
License: 29854 (TX)

Specialties & taxonomies

DentistPrimary122300000XLicense D-4605 (ID)
Dental Providers
Dentist122300000XLicense 29854 (TX)
Dental Providers

Practice location

1090 W Park Pl

Suite B

Coeur D Alene, ID 83814-2785

Phone: (208) 292-0303

Approximate (ZIP-level) locationGet directions

More ID providers

Mailing address

Po Box 3648

Coeur D'Alene, ID 83816

Registry dates

Enumerated: 2014-05-13
Last updated: 2020-08-17
Certified: 2020-08-17

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.