Licari, Gerald T

Licari, Gerald T is an individual health care provider with primary practice located at 1032 4Th Ave , Lake Odessa MI 48849-1004. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Licari, Gerald T can be contacted via phone (616) 374-8828.

Contact Information

Primary practice address
1032 4Th Ave Lake Odessa MI 48849-1004
Phone: (616) 374-8828
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 2901011834 Michigan

Profile Details

NPI number 1376630327
LBN Legal business name Licari, Gerald T
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 9th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376630327 NPPES
Michigan Other 11834 BLUE CROSS BLUE SHEILD
Michigan MEDICAID 4057629 BLUE CROSS BLUE SHEILD

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