Individual
DR. BRIAN JOSEPH LICARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3100 IVANREST AVE SW, SUITE # 104, GRANDVILLE, MI 49418-2930
(616) 531-0780
(616) 531-4677
Mailing address
5305 MCCORMICK DR SW, GRANDVILLE, MI 49418-8769
(616) 261-1589
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
18930
MI
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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