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General NPI Number Information
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NPI Number | 1912149956
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Entity Type | Individual
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Provider Name | KIRAN P RANGANATH B.D.S., M.P.H
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Gender | Male
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 2700 MARTIN LUTHER KING JR BLVD DC310
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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 | 313-494-6877
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 MARTIN LUTHER KING JR BLVD DC310
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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 | 313-494-6877
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 59000106
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901020768
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License Number State | MI
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