Provider Demographics
NPI:1821110537
Name:SHRIMANKAR, SANDRA MENEZES (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MENEZES
Last Name:SHRIMANKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2469
Mailing Address - Country:US
Mailing Address - Phone:734-929-9999
Mailing Address - Fax:734-929-9982
Practice Address - Street 1:2663 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2469
Practice Address - Country:US
Practice Address - Phone:734-929-9999
Practice Address - Fax:734-929-9982
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178861223G0001X
MI17886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice