Healthcare Provider Details

I. General information

NPI: 1740310473
Provider Name (Legal Business Name): RUSSELL S TAICHMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N. UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

2215 FULLER RD
ANN ARBOR MI
48105-2335
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-9952
  • Fax: 734-763-5503
Mailing address:
  • Phone: 734-764-9952
  • Fax: 734-763-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901016167
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901016167
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: