Provider Demographics
NPI:1437218963
Name:MICKEL, ANDRE KEVIN (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:KEVIN
Last Name:MICKEL
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 PARK EAST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-831-3636
Mailing Address - Fax:216-831-3639
Practice Address - Street 1:3609 PARK EAST
Practice Address - Street 2:SUITE 407
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-831-3636
Practice Address - Fax:216-831-3639
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300199471223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics