MEDICARE: DIKSHA THAPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901600880	MI

General Provider Information

NPI Number	:	1841871340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIKSHA THAPA

Provider Business Mailing Address
First Line	:	1833 MAPLE PARK DR E
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-4827
Country	:	US
Telephone Number	:	248-459-8130
Fax Number	:

Provider Business Practice Location Address
First Line	:	9840 HAGGERTY RD
Second Line	:
City	:	VAN BUREN TOWNSHIP
State	:	MI
Zip	:	48111-3443
Country	:	US
Telephone Number	:	734-687-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	04/25/2026

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