Dr. J Ryan Mickelson, D.D.S.
Dentist, General Practice in Durango, CO. Individual provider (NPI-1).
NPI number1346351624
StatusActive
Last updated in NPPESFeb 15, 2024
Details
- NPI
- 1346351624
- Entity type
- Individual (NPI-1)
- Name
- Dr. J Ryan Mickelson
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 31, 2006
- Certification date
- Feb 15, 2024
- Last updated
- Feb 15, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 8630 | CO | Yes |
| 1223G0001X | Dentist, General Practice | D-4547 | ID | |
| 1223G0001X | Dentist, General Practice | DD3644 | NM |
Practice location
2530 Colorado AveSuite 1a
Durango, CO 81301-4760
Phone 970-247-0174
Mailing address
2530 Colorado AveSuite 1a
Durango, CO 81301-4760
Phone 970-247-0174
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