Healthcare Provider Details

I. General information

NPI: 1942538285
Provider Name (Legal Business Name): VIVEK ANIL CHITTE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32316 FIVE MILE RD
LIVONIA MI
48154-6109
US

IV. Provider business mailing address

380 PELISSER AVE 1101
WINDSOR ONTARIO
N9A 6V7
CA

V. Phone/Fax

Practice location:
  • Phone: 734-523-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901020085
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901020085
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: