Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Chace Derrick Mickelson, DMD

Individual provider Dentist · NPI 1184035115

Dr. Chace Derrick Mickelson, DMD is a Dentist in Coeur D Alene, Idaho. Licensed in Idaho and Texas. Registered with an NPI since 2014.

Licensed in
ID, TX
In the registry since
2014
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

1090 W Park Pl Ste B
Coeur D Alene, ID 83814-2785
Phone: (208) 292-0303
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D-4605 (ID)
Dentist Taxonomy 122300000X · Licence 29854 (TX)

Record details

NPI number1184035115
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorNo
NPI enumeratedMay 13, 2014
Last updated in NPPESAugust 17, 2020
Certification dateAugust 17, 2020
Mailing addressPo Box 3648, Coeur D'Alene, ID 83816

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