| Wilson Dental Care Gr Pc | |
|
1625 Diamond Ave Ne Ste 1 Grand Rapids MI 49505-4887 | |
| (616) 454-1482 | |
| (616) 454-4422 |
| Full Name | Wilson Dental Care Gr Pc |
|---|---|
| Speciality | Dentist |
| Location | 1625 Diamond Ave Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Kathi A Wilson (OWNER) |
| Authorized Official Contact | 6164541482 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilson Dental Care Gr Pc 1625 Diamond Ave Ne Ste 1 Grand Rapids MI 49505-4887 Ph: (616) 454-1482 | Wilson Dental Care Gr Pc 1625 Diamond Ave Ne Ste 1 Grand Rapids MI 49505-4887 Ph: (616) 454-1482 |
| NPI Number | 1598007379 |
|---|---|
| Provider Enumeration Date | 03/20/2013 |
| Last Update Date | 03/20/2013 |
| Medicare PECOS PAC ID | 2264619550 |
|---|---|
| Medicare Enrollment ID | O20141216002093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598007379 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 17948 (Michigan) | Primary |
| Provider Name | Kathi A Wilson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1144291477 PECOS PAC ID: 4486792637 Enrollment ID: I20091110000185 |
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