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Organization
GERALD T LICARI DDS PC
Active
Organization
GERALD T LICARI DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD T LICARI DDS (PRESIDENT)
(616) 374-8828
Entity
Organization
Contact information
Practice address
1032 4TH AVE, LAKE ODESSA, MI 48849-1004
(616) 374-8828
Mailing address
1032 4TH AVE, LAKE ODESSA, MI 48849-1004
(616) 374-8828
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901011834
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11834
BLUE CROSS BLUE SHEILD
MI
05
—
4057629
—
MI
Enumeration date
10/09/2006
Last updated
08/22/2020
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