Michel Marie Wicksall DDS Plc
NPI #1053984591 in Grand Rapids, Michigan
Provider Information
- NPI Number
- 1053984591
- Entity Type
- Organization
- Organization Name
- Michel Marie Wicksall DDS Plc
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jul 22, 2021
- Last Updated
- Jul 22, 2021
Practice Location
- Address
- 4880 CASCADE RD SE STE B
- City
- Grand Rapids
- State
- Michigan
- ZIP Code
- 49546-3701
- Phone
- (616) 975-9700
Authorized Official
- Name
- MS. MICHEL WICKSALL
- Title
- OWNER
- Phone
- (616) 975-9700
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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