Healthcare Provider Details

I. General information

NPI: 1114018009
Provider Name (Legal Business Name): MITCHELL D. KAPLAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 PLATT RD SUITE 100
ANN ARBOR MI
48104-5149
US

IV. Provider business mailing address

2301 PLATT RD SUITE 100
ANN ARBOR MI
48104-5149
US

V. Phone/Fax

Practice location:
  • Phone: 734-975-2810
  • Fax: 734-975-2880
Mailing address:
  • Phone: 734-975-2810
  • Fax: 734-975-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901015329
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: