Healthcare Provider Details

I. General information

NPI: 1932769064
Provider Name (Legal Business Name): ELIZABETH VINCKIER KERSTEN DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 CAPAC RD
MUSSEY MI
48014-3186
US

IV. Provider business mailing address

4309 CAPAC RD
MUSSEY MI
48014-3186
US

V. Phone/Fax

Practice location:
  • Phone: 810-395-2100
  • Fax: 810-395-2100
Mailing address:
  • Phone: 810-395-2100
  • Fax: 810-395-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH VINCKIER KERSTEN
Title or Position: OWNER
Credential: DDS
Phone: 810-304-0258