Donald Jay Wickstra, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12270 Issued in MI

Practice address

3494 Lincoln Rd
Hamilton, MI 49419-9512

Phone

(269) 751-4601

Fax

(269) 751-4522

NPI assigned

May 12, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hamilton Dentistry PLLC

  • General Practice Dentistry
  • Hamilton, MI
  • NPI 1821302399
  NPD (past)

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1871544320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4023 134TH AVE",
            "city": "HAMILTON",
            "state": "MI",
            "postal_code": "494199564",
            "telephone_number": "269-751-4601",
            "fax_number": "269-751-4522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3494 LINCOLN RD",
            "city": "HAMILTON",
            "state": "MI",
            "postal_code": "494199512",
            "telephone_number": "269-751-4601",
            "fax_number": "269-751-4522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTRA",
        "first_name": "DONALD",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "12270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0004050379",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara E Tomman, D.C.
• Jessica Catherine Tubergen, PTA
• Visualeyes Center of Visual Development, PLLC
• West Michigan Rehabilitation PC
• Benjamin H Wickstra, DDS
• Wuis Value Drugs, Inc (Hamilton Family Pharmacy)

• General Practice Dentistry in Hamilton, MI
• Providers in Hamilton, 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 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.