Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901020313 | MI |
NPI | 1003126350 |
---|---|
Provider Name | Dr. Elham Javidan-Nejad |
First Address | Detroit, MI 48209-2157 |
Second Address | Detroit, MI 48209-2157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2010 |
Last Update Date | 16/01/2014 |