Provider Demographics
NPI:1760597066
Name:PERIODONTIC AND DENTAL IMPLANT CENTER
Entity Type:Organization
Organization Name:PERIODONTIC AND DENTAL IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:NIVEDITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MS
Authorized Official - Phone:734-975-1743
Mailing Address - Street 1:2755 CARPENTER RD
Mailing Address - Street 2:SUITE 2NE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1186
Mailing Address - Country:US
Mailing Address - Phone:734-975-1743
Mailing Address - Fax:734-975-1754
Practice Address - Street 1:2755 CARPENTER RD
Practice Address - Street 2:SUITE 2NE
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1186
Practice Address - Country:US
Practice Address - Phone:734-975-1743
Practice Address - Fax:734-975-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016548385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care