Healthcare Provider Details

I. General information

NPI: 1629281274
Provider Name (Legal Business Name): DANIEL PAUL ZICK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 LAKE LANSING RD
LANSING MI
48912-3659
US

IV. Provider business mailing address

2522 BURCHAM DR
EAST LANSING MI
48823-7238
US

V. Phone/Fax

Practice location:
  • Phone: 517-484-4455
  • Fax: 517-484-4457
Mailing address:
  • Phone: 517-332-5409
  • Fax: 517-484-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901014170
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: