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Individual
AMY R. LALICK
Active
Individual
AMY R. LALICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901018065
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4535594
—
MI
01
—
BC00473
BLUE CROSS BLUE SHEILD MI
MI
Enumeration date
06/13/2006
Last updated
07/16/2015
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