Healthcare Provider Details

I. General information

NPI: 1013957281
Provider Name (Legal Business Name): JEEVAKA YAPA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30555 GREENFIELD RD
SOUTHFIELD MI
48076-1594
US

IV. Provider business mailing address

30555 GREENFIELD RD
SOUTHFIELD MI
48076-1594
US

V. Phone/Fax

Practice location:
  • Phone: 248-262-9100
  • Fax: 248-262-9104
Mailing address:
  • Phone: 248-262-9100
  • Fax: 248-262-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number16026
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: