Individual
DR. MICHAEL JOHN WIERENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4320 44TH ST SW, STE 106, GRANDVILLE, MI 49418-2300
(616) 530-2200
(616) 530-8250
Mailing address
185 LAKE VILLAGE DR APT 203, ANN ARBOR, MI 48103-6539
(616) 723-6762
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901020644
MI
Other
Enumeration date
05/18/2012
Last updated
05/18/2012
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