Individual
DR. DONALD JAY WICKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3494 LINCOLN RD, HAMILTON, MI 49419-9512
(269) 751-4601
(269) 751-4522
Mailing address
4023 134TH AVE, HAMILTON, MI 49419-9564
(269) 751-4601
(269) 751-4522
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12270
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004050379
—
MI
Enumeration date
05/12/2006
Last updated
07/09/2007
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