Organization
MICHEL MARIE WICKSALL DDS PLC
Active
Other names
Michel Marie Wicksall DDS
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHEL WICKSALL (OWNER)
(616) 975-9700
Entity
Organization
Contact information
Practice address
4880 CASCADE RD SE STE B, GRAND RAPIDS, MI 49546-3701
(616) 975-9700
(616) 975-9750
Mailing address
4880 CASCADE RD SE STE B, GRAND RAPIDS, MI 49546-3701
(616) 975-9700
(616) 975-9750
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/22/2021
Last updated
07/22/2021
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