Organization
BENJAMIN H WICKSTRA DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN WICKSTRA DDS (PRESIDENT)
(616) 218-5795
Entity
Organization
Contact information
Practice address
99 W 26TH ST, HOLLAND, MI 49423-4970
(616) 218-5795
Mailing address
567 CENTRAL AVE, HOLLAND, MI 49423-4848
(616) 218-5795
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770763583
—
MI
Enumeration date
10/25/2011
Last updated
10/25/2011
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