Individual
DR. NICHOLAS GEORGE RACINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5916 LAKE MICHIGAN DR, ALLENDALE, MI 49401-8111
(616) 259-6046
Mailing address
5916 LAKE MICHIGAN DR, ALLENDALE, MI 49401-8111
(616) 259-6046
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901600897
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901600897
DENTIST LICENSE #
MI
Enumeration date
05/25/2021
Last updated
05/25/2021
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