=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255416418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INDUMATHI PAI DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28535 ORCHARD LAKE ROAD SUITE 400
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-848-1126
-----------------------------------------------------
Fax | 248-848-1190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28535 ORCHARD LAKE ROAD SUITE 400
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-848-1126
-----------------------------------------------------
Fax | 248-848-1190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901014906
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------