Provider Demographics
NPI:1821118142
Name:WICK ROAD DENTAL CENTER
Entity Type:Organization
Organization Name:WICK ROAD DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARONOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-291-2600
Mailing Address - Street 1:22350 WICK RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3607
Mailing Address - Country:US
Mailing Address - Phone:313-291-2600
Mailing Address - Fax:313-291-0731
Practice Address - Street 1:22350 WICK RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3607
Practice Address - Country:US
Practice Address - Phone:313-291-2600
Practice Address - Fax:313-291-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID89691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty