=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376650101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHIGAN DENTAL CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6276 JACKSON ROAD STE A
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-222-3636
-----------------------------------------------------
Fax | 734-222-5454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6276 JACKSON ROAD STE A
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-222-3636
-----------------------------------------------------
Fax | 734-222-5454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PARESH V SHRIMANKAR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 734-222-3636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 17664
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 18228
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 16549
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------