Provider Demographics
NPI:1669796538
Name:UNSICKER, JOHN (LD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:UNSICKER
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9597 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2424
Mailing Address - Country:US
Mailing Address - Phone:833-900-1050
Mailing Address - Fax:833-200-5256
Practice Address - Street 1:1251 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4148
Practice Address - Country:US
Practice Address - Phone:253-300-1860
Practice Address - Fax:833-200-5256
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR9BJDE7P6KMedicare PIN