Healthcare Provider Details

I. General information

NPI: 1689538571
Provider Name (Legal Business Name): NAMITA GANDHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

35454 RAVINE BLVD # 23206
FARMINGTON HILLS MI
48335-2467
US

V. Phone/Fax

Practice location:
  • Phone: 131-349-4670
  • Fax:
Mailing address:
  • Phone: 947-254-4158
  • Fax: 947-254-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2952000887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: