Individual
DR. GERALD T LICARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1032 4TH AVE, LAKE ODESSA, MI 48849-1004
(616) 374-8828
Mailing address
1032 4TH AVE, LAKE ODESSA, MI 48849-1004
(616) 374-8828
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901011834
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11834
BLUE CROSS BLUE SHEILD
MI
05
—
4057629
—
MI
Enumeration date
10/09/2006
Last updated
07/08/2007
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