Michel Marie Wicksall DDS Plc
Dentist, General Practice in Grand Rapids, MI. Organization (NPI-2).
NPI number1053984591
StatusActive
Last updated in NPPESJul 22, 2021
Details
- NPI
- 1053984591
- Entity type
- Organization (NPI-2)
- Legal business name
- Michel Marie Wicksall DDS Plc
- Organization subpart
- No
- Enumeration date
- Jul 22, 2021
- Certification date
- Jul 22, 2021
- Last updated
- Jul 22, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Michel Marie Wicksall DDS (Doing Business As)
Practice location
4880 Cascade Rd Se Ste BGrand Rapids, MI 49546-3701
Phone 616-975-9700 · Fax 616-975-9750
Mailing address
4880 Cascade Rd Se Ste BGrand Rapids, MI 49546-3701
Phone 616-975-9700 · Fax 616-975-9750
Authorized official
Michel Wicksall
Owner
6169759700
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