Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901017792 | MI |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2901017792 | MI |
NPI | 1578687315 |
---|---|
Provider Name | Nisha J D'silva |
First Address | Toledo, OH 43614-1509 |
Second Address | Ann Arbor, MI 48109-1078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 29/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19009265 | MEDICARE RAILROAD (01) | MI |
1958162970 | BCBS OF MI MED SURGICAL (01) | MI |
4165789 | (05) | MI |
4873706 | (05) | MI |
D017792 | BCBS OF MI DENTAL (01) | MI |
U78086 | (02) | MI |