| Michel Marie Wicksall Dds Plc | |
|
4880 Cascade Rd Se Ste B Grand Rapids MI 49546-3701 | |
| (616) 975-9700 | |
| (616) 975-9750 |
| Full Name | Michel Marie Wicksall Dds Plc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4880 Cascade Rd Se Ste B, Grand Rapids, Michigan |
| Authorized Official Name and Position | Michel Wicksall (OWNER) |
| Authorized Official Contact | 6169759700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michel Marie Wicksall Dds Plc 4880 Cascade Rd Se Ste B Grand Rapids MI 49546-3701 Ph: (616) 975-9700 | Michel Marie Wicksall Dds Plc 4880 Cascade Rd Se Ste B Grand Rapids MI 49546-3701 Ph: (616) 975-9700 |
| NPI Number | 1053984591 |
|---|---|
| Provider Enumeration Date | 07/22/2021 |
| Last Update Date | 07/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053984591 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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