| Gerald T Licari Dds Pc | |
|
1032 4th Ave Lake Odessa MI 48849-1004 | |
| (616) 374-8828 | |
| Not Available |
| Full Name | Gerald T Licari Dds Pc |
|---|---|
| Speciality | Dentist |
| Location | 1032 4th Ave, Lake Odessa, Michigan |
| Authorized Official Name and Position | Gerald T Licari (PRESIDENT) |
| Authorized Official Contact | 6163748828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gerald T Licari Dds Pc 1032 4th Ave Lake Odessa MI 48849-1004 Ph: (616) 374-8828 | Gerald T Licari Dds Pc 1032 4th Ave Lake Odessa MI 48849-1004 Ph: (616) 374-8828 |
| NPI Number | 1215024369 |
|---|---|
| Provider Enumeration Date | 10/09/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215024369 | NPI | - | NPPES |
| 4057629 | Medicaid | MI | |
| 11834 | Other | MI | BLUE CROSS BLUE SHEILD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901011834 (Michigan) | Primary |
Alex T. Hoelzel, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1032 4th Ave, Lake Odessa, MI 48849 Phone: 616-374-8828 | |
Lake Odessa Dental Associates Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1032 4th Ave, Lake Odessa, MI 48849 Phone: 616-374-8828 Fax: 616-374-7934 |