Provider Demographics
NPI:1245559525
Name:BICKEL, MICAH NATHANAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:NATHANAEL
Last Name:BICKEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OLD NACHES HWY
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9036
Mailing Address - Country:US
Mailing Address - Phone:206-225-4536
Mailing Address - Fax:
Practice Address - Street 1:800 OLD NACHES HWY
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9036
Practice Address - Country:US
Practice Address - Phone:206-225-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601049881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice