Provider Demographics
NPI:1457527533
Name:GRIGAITIS, NIKA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIKA
Middle Name:
Last Name:GRIGAITIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19510 CLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1746
Mailing Address - Country:US
Mailing Address - Phone:248-946-0217
Mailing Address - Fax:
Practice Address - Street 1:19510 CLEMENT RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1746
Practice Address - Country:US
Practice Address - Phone:248-946-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010197481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice