Provider Demographics
NPI:1700907946
Name:MIKKELSEN, FRANK (DDS)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:MIKKELSEN
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 1:19060 STANDARD RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-7542
Mailing Address - Country:US
Mailing Address - Phone:209-532-4607
Mailing Address - Fax:209-533-5487
Practice Address - Street 1:19060 STANDARD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-7542
Practice Address - Country:US
Practice Address - Phone:209-532-4607
Practice Address - Fax:209-533-5487
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist