Provider Demographics
NPI:1366480253
Name:EICK, VIRGINIA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:EICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10407 GRAND RIVER RD
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010171631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice