Provider Demographics
NPI:1609508464
Name:REKKEN, MIKAYLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKAYLA
Middle Name:
Last Name:REKKEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E JEFFERSON ST APT 718
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-0407
Mailing Address - Country:US
Mailing Address - Phone:701-430-6854
Mailing Address - Fax:
Practice Address - Street 1:15260 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2530
Practice Address - Country:US
Practice Address - Phone:623-207-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty