Healthcare Provider Details

I. General information

NPI: 1063598241
Provider Name (Legal Business Name): HENRY FRANKLIN HERLICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5095 RIFLE RIVER TRL
ALGER MI
48610-9327
US

IV. Provider business mailing address

5095 RIFLE RIVER TRL
ALGER MI
48610-9327
US

V. Phone/Fax

Practice location:
  • Phone: 989-654-2491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901009842
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: