Healthcare Provider Details

I. General information

NPI: 1871798314
Provider Name (Legal Business Name): NIVEDITA KUMAR BDS,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 CARPENTER RD STE 2
ANN ARBOR MI
48108-1186
US

IV. Provider business mailing address

2755 CARPENTER ROAD STE 2 NE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-975-1743
  • Fax: 734-975-1754
Mailing address:
  • Phone: 734-975-1743
  • Fax: 734-975-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901016548
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: