Healthcare Provider Details

I. General information

NPI: 1174028112
Provider Name (Legal Business Name): YASH KAPADIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 S PENNSYLVANIA AVE
LANSING MI
48910-1897
US

IV. Provider business mailing address

23326 PORTAGE WAY APT 2412
NOVI MI
48375-5400
US

V. Phone/Fax

Practice location:
  • Phone: 517-208-0255
  • Fax:
Mailing address:
  • Phone: 929-285-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number21729
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: