# BENJAMIN H. WICKSTRA DDS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BH WICKSTRA DDS PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1851685226
- **Legal business name:** BH WICKSTRA DDS PC
- **Authorized official:** DR. BENJAMIN H WICKSTRA D.D.S. (PRESIDENT)
- **Authorized official phone:** (616) 218-5795

## Contact information

- **Practice address:** 567 CENTRAL AVE, HOLLAND, MI 49423-4848
- **Practice address phone:** (616) 218-5795
- **Mailing address:** 567 CENTRAL AVE, HOLLAND, MI 49423-4848
- **Mailing address phone:** (616) 218-5795

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2901019584 | MI | Yes |

## Other

- **Enumeration date:** 06/02/2011
- **Last updated:** 06/02/2011