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Provider Information for 1982964045



DR. SOREN CHASE MICHAELSEN DDS

Gender: MALE

Individual NPI: 1982964045

Calendar Last Updated: 2018-05-31

Details

Name Value
NPI 1982964045
Enumeration Date 2012-05-23
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2036 S. MILLER LANE SUITE #B
CATOOSA, OK 74015
United States

Phone: 918-266-6470 | Fax: 918-266-6473
View Map External Link
Primary Practice Address 1755 N HIGHWAY 66 SUITE C
CATOOSA, OK 74015
United States

Phone: 918-266-6470 | Fax: 918-266-6473
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice OK 6403