Healthcare Provider Details

I. General information

NPI: 1154637007
Provider Name (Legal Business Name): SANGEETA PRATHIPATI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2010
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 MADISON AVE
TOLEDO OH
43604-5131
US

IV. Provider business mailing address

2275 HICKORY POINT DR
ANN ARBOR MI
48105-9291
US

V. Phone/Fax

Practice location:
  • Phone: 419-241-1644
  • Fax:
Mailing address:
  • Phone: 734-369-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020366
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30023222
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: