Individual
JANE WICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
20 PORTER ST, WENHAM, MA 01984-1426
(978) 468-2911
Mailing address
17 SCHOOL ST, BYFIELD, MA 01922-1610
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
17148
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XO6701
BLUE CROSS BLUE SHIELD
MA
Enumeration date
02/01/2007
Last updated
07/08/2007
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