Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901017962 | MI |
NPI | 1003970245 |
---|---|
Provider Name | Keiko Kikuchi De Beltran |
First Address | Novi, MI 48375 |
Second Address | Novi, MI 48375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |