Michel Marie Wicksall DDS PLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MICHEL MARIE WICKSALL DDS PLC

Practice address

4880 Cascade Rd SE Ste B
Grand Rapids, MI 49546-3701

Phone

(616) 975-9700

Fax

(616) 975-9750

NPI assigned

Jul 22, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Michel WicksallNPI 1912165556

Title

Owner

Phone

(616) 975-9700

Specialties & licenses 1

Addresses

Other names 1

• Michel Marie Wicksall DDS Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michel Marie Wicksall, DDS

  • Dentist
  • Grand Rapids, MI
  • NPI 1912165556
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1053984591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4880 CASCADE RD SE STE B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463701",
            "telephone_number": "616-975-9700",
            "fax_number": "616-975-9750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4880 CASCADE RD SE STE B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463701",
            "telephone_number": "616-975-9700",
            "fax_number": "616-975-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHEL MARIE WICKSALL DDS PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "WICKSALL",
        "authorized_official_first_name": "MICHEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-975-9700",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michel Marie Wicksall DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Max Michalak, PA
• Elizabeth Michalek
• Alexis Michals, IBCLC
• Aaron Michael Michaud, PA
• Ashleigh Collar Michaud, PA-C
• Elizabeth Ann Michel, PA-C
• Michael Andrew Michelakis, MD
• Tami Joy Michele, DO
• Erika Michelin, DO
• Christopher Michels

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.