Healthcare Provider Details

I. General information

NPI: 1467384081
Provider Name (Legal Business Name): NORTHSIDE PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GREEN RD
ANN ARBOR MI
48105-1598
US

IV. Provider business mailing address

2400 WESTBROOKE CIR S
ANN ARBOR MI
48105-3143
US

V. Phone/Fax

Practice location:
  • Phone: 254-733-5260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MINJOO SANKER
Title or Position: OWNER
Credential: DDS
Phone: 254-733-5260