Organization
GRANDVILLE ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN JOSEPH LICARI DDS (PRESIDENT)
(616) 531-0780
Entity
Organization
Contact information
Practice address
3100 IVANREST AVE SW, SUITE 104, GRANDVILLE, MI 49418-2930
(616) 531-0780
(616) 531-4677
Mailing address
3100 IVANREST AVE SW, SUITE 104, GRANDVILLE, MI 49418-2930
(616) 531-0780
(616) 531-4677
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
04/28/2008
Last updated
04/28/2008
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