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General NPI Number Information
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NPI Number | 1710303870
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Entity Type | Organization
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Legal Business Name | EZ DENTAL PC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 2663 PLYMOUTH RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2469
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Country | US
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Telephone | 734-929-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 2663 PLYMOUTH RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2469
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Country | US
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Telephone | 734-929-9999
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Fax |
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | DR. SANDRA SHRIMANKAR
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Credential | DDS
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Telephone | 734-929-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17886
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License Number State | MI
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