Individual
KEVIN KOOIKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
101 SHELDON BLVD SE, GRAND RAPIDS, MI 49503-4262
(616) 776-2340
(616) 776-2341
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
2901017902
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4525382
—
MI
05
—
4535790
—
MI
01
—
D179020
BCBS
MI
Enumeration date
08/15/2006
Last updated
07/08/2007
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