Provider Demographics
NPI:1306417522
Name:PARTHASARATHY SRINIVASAN, DIVYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:PARTHASARATHY SRINIVASAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:DIVYA
Other - Middle Name:
Other - Last Name:ARVIND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44898 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33080 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1867
Practice Address - Country:US
Practice Address - Phone:586-293-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016009811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice