OrganizationActive
Nicholas Mickelson LLC
NPI 1679178271 · Dental Clinic/Center · Tampa, FL
Provider details
- NPI number
- 1679178271
- Entity type
- Organization
- Primary specialty
- Dental Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Maisa Mickelson, Office Manager(813) 616-9019
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
13612 W Hillsborough Ave
Tampa, FL 33635-9638
Phone: (813) 444-7502
Street-level locationGet directions
Mailing address
8805 Rustic Trail Ct
Tampa, FL 33635-1557
Other names (DBA / former)
- Doing business as
- Nova Dental
Registry dates
- Enumerated
- 2020-12-01
- Last updated
- 2020-12-01
- Certified
- 2020-11-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.