Provider Demographics
NPI:1932769064
Name:ELIZABETH VINCKIER KERSTEN DDS PLLC
Entity Type:Organization
Organization Name:ELIZABETH VINCKIER KERSTEN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:VINCKIER
Authorized Official - Last Name:KERSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-304-0258
Mailing Address - Street 1:4309 CAPAC RD
Mailing Address - Street 2:
Mailing Address - City:MUSSEY
Mailing Address - State:MI
Mailing Address - Zip Code:48014-3186
Mailing Address - Country:US
Mailing Address - Phone:810-395-2100
Mailing Address - Fax:810-395-2100
Practice Address - Street 1:4309 CAPAC RD
Practice Address - Street 2:
Practice Address - City:MUSSEY
Practice Address - State:MI
Practice Address - Zip Code:48014-3186
Practice Address - Country:US
Practice Address - Phone:810-395-2100
Practice Address - Fax:810-395-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental