Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2901600230 | MI |
NPI | 1093368821 |
---|---|
Provider Name | Laxmi Sukhtankar |
First Address | Troy, MI 48083-4372 |
Second Address | New Boston, MI 48164-9357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2019 |
Last Update Date | 21/07/2019 |