Provider Demographics
NPI:1649237595
Name:KRISHNAN, VEJAYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VEJAYAN
Middle Name:
Last Name:KRISHNAN
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 1:3419 DALEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9686
Mailing Address - Country:US
Mailing Address - Phone:734-913-9227
Mailing Address - Fax:
Practice Address - Street 1:32905 W 12 MILE RD
Practice Address - Street 2:#200
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3342
Practice Address - Country:US
Practice Address - Phone:248-553-3280
Practice Address - Fax:248-553-2913
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010163421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U45544Medicare UPIN