Provider Demographics
NPI:1760577852
Name:GERALD T MIKEL FAMILY DENTISTRY SC
Entity type:Organization
Organization Name:GERALD T MIKEL FAMILY DENTISTRY SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MIKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-392-1132
Mailing Address - Street 1:3312 TOWER AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880
Mailing Address - Country:US
Mailing Address - Phone:715-392-1132
Mailing Address - Fax:715-392-2333
Practice Address - Street 1:3312 TOWER AVENUE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880
Practice Address - Country:US
Practice Address - Phone:715-392-1132
Practice Address - Fax:715-392-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty