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General NPI Number Information
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NPI Number | 1750990164
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Entity Type | Organization
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Legal Business Name | DIWAKAR KINRA PC
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 5409 GATEWAY CTR STE F
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City | FLINT
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State | MI
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Zip | 48507-3992
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Country | US
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Telephone | 810-235-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 5409 GATEWAY CTR STE F
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City | FLINT
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State | MI
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Zip | 48507-3992
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Country | US
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Telephone | 810-235-0100
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Fax |
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Authorized Official
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Title or Position | PATIENT COORDINATOR
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Name | CRISTINA A BAGWELL
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Credential |
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Telephone | 810-235-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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