| NPI | 1538139076 |
|---|---|
| Former Name | DEBORAH MARIE MICKELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN17382) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17382) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2024-06-17 |