Individual
MASON MCGILLICUDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
(616) 940-5366
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
(616) 940-5366
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
UNKNOWN
MI
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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