Active NPI
Michel Marie Wicksall, DDS
- Dentist
- Grand Rapids, MI
National Provider Identifier
1912165556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 16961
- Practice address
- 4500 Cascade Rd SE
200
Grand Rapids, MI 49546 - Phone
- (616) 975-9700
- Fax
- (616) 975-9750
- NPI assigned
- May 30, 2008
- Last updated
- May 30, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 16961 | MI | Primary |
Addresses
Primary practice location
4500 Cascade Rd SE
200
Grand Rapids, MI 49546
Mailing address
4500 Cascade Rd SE
200
Grand Rapids, MI 49546
Phone (616) 975-9700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16961 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michel Marie Wicksall DDS PLC | Current | Accepting new patients |
Organizations & group practices 1
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.
-
dba Michel Marie Wicksall DDS
- General Practice Dentistry
- Grand Rapids, MI
- NPI 1053984591
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212105600000",
"number": "1912165556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 CASCADE RD SE",
"address_2": "200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49546",
"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": "4500 CASCADE RD SE",
"address_2": "200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49546",
"telephone_number": "616-975-9700",
"fax_number": "616-975-9750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKSALL",
"first_name": "MICHEL",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-30",
"last_updated": "2008-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "16961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.