Provider Demographics
NPI:1134400781
Name:POOJARY, PRATHVI (DDS)
Entity type:Individual
Prefix:DR
First Name:PRATHVI
Middle Name:
Last Name:POOJARY
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 1:19451 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3361
Mailing Address - Country:US
Mailing Address - Phone:313-271-1800
Mailing Address - Fax:313-945-1810
Practice Address - Street 1:19451 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3361
Practice Address - Country:US
Practice Address - Phone:313-271-1800
Practice Address - Fax:313-945-1810
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288701223G0001X
MI29010205161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice