Provider Demographics
NPI:1982964045
Name:MICHAELSEN, SOREN CHASE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOREN
Middle Name:CHASE
Last Name:MICHAELSEN
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 1:2036 S. MILLER LANE
Mailing Address - Street 2:SUITE #B
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015
Mailing Address - Country:US
Mailing Address - Phone:918-266-6470
Mailing Address - Fax:918-266-6473
Practice Address - Street 1:1755 N HIGHWAY 66
Practice Address - Street 2:SUITE C
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015
Practice Address - Country:US
Practice Address - Phone:918-266-6470
Practice Address - Fax:918-266-6473
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice