Healthcare Provider Details

I. General information

NPI: 1598857336
Provider Name (Legal Business Name): SHILPA KOLHATKAR DDS, MDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40400 ANN ARBOR RD E SUITE 204A
PLYMOUTH MI
48170-6615
US

IV. Provider business mailing address

40400 ANN ARBOR RD E SUITE 204A
PLYMOUTH MI
48170-6615
US

V. Phone/Fax

Practice location:
  • Phone: 734-459-4077
  • Fax:
Mailing address:
  • Phone: 734-459-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901018336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: