Provider Demographics
NPI:1942313598
Name:DRS CHARLICK SPRINGSTEAD & WILSON DENTAL ASSOC PC
Entity Type:Organization
Organization Name:DRS CHARLICK SPRINGSTEAD & WILSON DENTAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHARLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-229-9346
Mailing Address - Street 1:5710 WHITMORE LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116
Mailing Address - Country:US
Mailing Address - Phone:810-229-9346
Mailing Address - Fax:810-229-2688
Practice Address - Street 1:5710 WHITMORE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116
Practice Address - Country:US
Practice Address - Phone:810-229-9346
Practice Address - Fax:810-229-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty