Provider Demographics
NPI:1316398902
Name:KUMAR, PAVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAVAN
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1630
Mailing Address - Country:US
Mailing Address - Phone:248-439-0088
Mailing Address - Fax:248-439-2900
Practice Address - Street 1:2790 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1630
Practice Address - Country:US
Practice Address - Phone:248-439-0088
Practice Address - Fax:248-439-2900
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist