Provider Demographics
NPI:1982892071
Name:MICHEL, VICKI R (DDS)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:R
Last Name:MICHEL
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 1:1209 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5601
Mailing Address - Country:US
Mailing Address - Phone:701-252-0251
Mailing Address - Fax:
Practice Address - Street 1:1209 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5601
Practice Address - Country:US
Practice Address - Phone:701-252-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40713Medicaid
ND901609OtherDENTAL SERVICE CORP.