| NPI | 1851685226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN H WICKSTRA President 616-218-5795 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019584) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2011-06-02 |