Healthcare Provider Details

I. General information

NPI: 1558920710
Provider Name (Legal Business Name): NICOLE RIGAS NAIDOO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. MEDICAL CENTER DRIVE MEDINN C213, SPC 5831
ANN ARBOR MI
48109-5831
US

IV. Provider business mailing address

22201 MOROSS RD STE 155
DETROIT MI
48236-2152
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5950
  • Fax:
Mailing address:
  • Phone: 313-499-4775
  • Fax: 313-499-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2951000661
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: