Benjamin H Wickstra, DDS
Individual provider Active NPI General Practice Dentistry · Hamilton, MI
NPI 1770763583 · NPPES record last updated Jul 16, 2008
Key facts
- NPI
- 1770763583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2901019584 (MI)
- Practice address
- 3494 Lincoln Rd
Hamilton Medical Center
Hamilton, MI 49419 - Phone
- (269) 751-4601
- NPI assigned
- Nov 8, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160108002141 | MI | Order and Referring Only - Dentist |
4688976566 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hamilton Dentistry PLLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901019584 | MI | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
3494 Lincoln Rd
Hamilton Medical Center
Hamilton, MI 49419
Mailing address
PO Box 256
Hamilton, MI 49419-0256
Phone (269) 751-4601
Other providers in Hamilton, MI
- Alicia Tock
- Tara E Tomman
- Jessica Catherine Tubergen
- Visualeyes Center of Visual Development, PLLC
- West Michigan Rehabilitation PC
- Donald Jay Wickstra
- Wuis Value Drugs, Inc
All providers in Hamilton, MI · General Practice Dentistry in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.