CHACE DERRICK MICKELSON

COEUR D ALENE, ID
NPI1184035115
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy122300000X Dentist
(Licence: ID  D-4605)
Additional Taxonomies122300000X Dentist
(Licence: TX  29854)
Enumeration Date2014-05-13
Last Update Date2020-08-17
Business Address
Dr. CHACE DERRICK MICKELSON D.M.D
1090 W PARK PL SUITE B
COEUR D ALENE, ID 83814-2785
Phone number: 208-292-0303
Mailing Address
Dr. CHACE DERRICK MICKELSON D.M.D
PO BOX 3648
COEUR D'ALENE, ID 83816
Phone number: 208-292-0292
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