Healthcare Provider Details

I. General information

NPI: 1306276787
Provider Name (Legal Business Name): ARCHANA RAJAN DDS,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 MARTIN L. KING BLVD
LANSING MI
48910
US

IV. Provider business mailing address

5050 SCHAEFER RD
DEARBORN MI
48126-3249
US

V. Phone/Fax

Practice location:
  • Phone: 517-394-1495
  • Fax: 517-394-6478
Mailing address:
  • Phone: 313-582-8150
  • Fax: 313-582-0745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901020105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: