Individual
LARRY WILDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
2515 ALPINE AVE NW, SUITE A, GRAND RAPIDS, MI 49544-1924
(616) 364-9348
(616) 364-5950
Mailing address
1344 WINTERWOOD DR NE, GRAND RAPIDS, MI 49525-3441
(616) 364-9348
(616) 364-5950
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11365
MI
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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