Individual
NICOLE KOOIKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
751 LAFAYETTE AVE NE, GRAND RAPIDS, MI 49503-1628
(616) 742-9941
Mailing address
550 CHERRY ST SE, GRAND RAPIDS, MI 49503-4748
(616) 235-7280
(616) 752-4119
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901018147
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4379794
—
MI
05
—
4525391
—
MI
01
—
D181470
BCBS
MI
Enumeration date
08/15/2006
Last updated
07/08/2007
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