Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2901019850 | MI |
NPI | 1083879514 |
---|---|
Provider Name | Dr. Ana Janic |
First Address | Warren, MI 48093-3570 |
Second Address | Warren, MI 48093-3570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 24/07/2008 |