Provider Demographics
NPI:1245612134
Name:VIRGINIA E. EICK, DDS, PC
Entity Type:Organization
Organization Name:VIRGINIA E. EICK, DDS, PC
Other - Org Name:THOMAS T. CLAFLIN, DDS, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:EICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-227-6567
Mailing Address - Street 1:10407 GRAND RIVER RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6532
Mailing Address - Country:US
Mailing Address - Phone:810-227-6567
Mailing Address - Fax:810-227-7166
Practice Address - Street 1:10407 GRAND RIVER RD
Practice Address - Street 2:SUITE 900
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6532
Practice Address - Country:US
Practice Address - Phone:810-227-6567
Practice Address - Fax:810-227-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty