Gerald T Licari DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

2901011834 Issued in MI

Legal business name

GERALD T LICARI DDS PC

Practice address

1032 4TH Ave
Lake Odessa, MI 48849-1004

Phone

(616) 374-8828

NPI assigned

Oct 9, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gerald T Licari, DDSNPI 1376630327

Title

President

Phone

(616) 374-8828

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gerald T Licari, DDS

  • Dentist
  • Lake Odessa, MI
  • NPI 1376630327
  NPD (past) Authorized official

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215024369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 4TH AVE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488491004",
            "telephone_number": "616-374-8828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 4TH AVE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488491004",
            "telephone_number": "616-374-8828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERALD T LICARI DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LICARI",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-374-8828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901011834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4057629",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "11834",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brianna Alexis Eisaman, DO
• Enz Counseling Services LLC
• Jennifer Lyn Fletcher
• Katlyn Franke, MD
• Aaron Blane Freeman, D.D.S
• Deb Giaseman
• Kristen Nicole Gilley, PA-C
• Catherine Hemingway, R.D.H
• John P. Hemming, O.D.
• Chad Ronald Hickey, D.C.

• Dentist in Lake Odessa, MI
• Providers in Lake Odessa, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.