Provider Demographics
NPI:1922458488
Name:FRANK MIKKELSEN DDS
Entity Type:Organization
Organization Name:FRANK MIKKELSEN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKKELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-532-4607
Mailing Address - Street 1:19060 STANDARD RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-7560
Mailing Address - Country:US
Mailing Address - Phone:209-532-4607
Mailing Address - Fax:209-533-5487
Practice Address - Street 1:19060 STANDARD RD STE 4
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-7560
Practice Address - Country:US
Practice Address - Phone:209-532-4607
Practice Address - Fax:209-533-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30435332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment