Organization
BENJAMIN H. WICKSTRA DDS, PLLC
Active
Parent organization
BH WICKSTRA DDS PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BH WICKSTRA DDS PC
Authorized official
DR. BENJAMIN H WICKSTRA D.D.S. (PRESIDENT)
(616) 218-5795
Entity
Organization
Contact information
Practice address
567 CENTRAL AVE, HOLLAND, MI 49423-4848
(616) 218-5795
Mailing address
567 CENTRAL AVE, HOLLAND, MI 49423-4848
(616) 218-5795
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901019584
MI
Other
Enumeration date
06/02/2011
Last updated
06/02/2011
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