Healthcare Provider Details

I. General information

NPI: 1649313503
Provider Name (Legal Business Name): JULIE D CICHORACKI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 S WATER ST
MARINE CITY MI
48039-1687
US

IV. Provider business mailing address

1868 STANHOPE ST
GROSSE POINTE WOODS MI
48236-1906
US

V. Phone/Fax

Practice location:
  • Phone: 810-765-4055
  • Fax:
Mailing address:
  • Phone: 810-357-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019164
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: