Healthcare Provider Details

I. General information

NPI: 1841871340
Provider Name (Legal Business Name): DIKSHA THAPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9840 HAGGERTY RD
VAN BUREN TOWNSHIP MI
48111-3443
US

IV. Provider business mailing address

1833 MAPLE PARK DR E
CANTON MI
48188-4827
US

V. Phone/Fax

Practice location:
  • Phone: 734-687-4400
  • Fax:
Mailing address:
  • Phone: 248-459-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901600880
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: