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General NPI Number Information
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NPI Number | 1295353779
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Entity Type | Individual
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Provider Name | KRUNAL PUNJABI
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Gender | Male
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 2700 MARTIN LUTHER KING JR BLVD
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City | DETROIT
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State | MI
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Zip | 48208-2576
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Country | US
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Telephone | 313-494-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 36078 ANN ARBOR TRL
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City | LIVONIA
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State | MI
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Zip | 48150-3580
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Country | US
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Telephone | 586-770-1205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS-09799
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2952000772
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License Number State | MI
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