NPIMap

Organization Active NPI

Benjamin H. Wickstra DDS, PLLC

  • General Practice Dentistry
  • Holland, MI
National Provider Identifier
1851685226
Registry record updated Jun 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901019584 Issued in MI
Legal business name
BENJAMIN H. WICKSTRA DDS, PLLC
Practice address
567 Central Ave
Holland, MI 49423-4848
Phone
(616) 218-5795
NPI assigned
Jun 2, 2011
Organization subpart
Yes
Parent organization
BH WICKSTRA DDS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 2, 2011

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

Authorized official

Name
Dr. Benjamin H Wickstra, D.D.S.
Title
President
Phone
(616) 218-5795

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2901019584 MI Primary

Addresses

Primary practice location

567 Central Ave
Holland, MI 49423-4848

Mailing address

567 Central Ave
Holland, MI 49423-4848
Phone (616) 218-5795

National Provider Directory

National Provider Directory
Tax ID family
Benjamin H Wickstra DDS PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306972800000",
    "number": "1851685226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 CENTRAL AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234848",
            "telephone_number": "616-218-5795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 CENTRAL AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234848",
            "telephone_number": "616-218-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENJAMIN H. WICKSTRA DDS, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BH WICKSTRA DDS PC",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-06-02",
        "status": "A",
        "authorized_official_last_name": "WICKSTRA",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-218-5795",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; 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.