# PERIODONTIC AND DENTAL IMPLANT CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760597066
- **Authorized official:** NIVEDITA S KUMAR B.D.S., M.S. (PERIODONTIST)
- **Authorized official phone:** (734) 975-1743

## Contact information

- **Practice address:** 2755 CARPENTER RD, SUITE 2NE, ANN ARBOR, MI 48108-1186
- **Practice address phone:** (734) 975-1743
- **Practice address fax:** (734) 975-1754
- **Mailing address:** 2755 CARPENTER RD, SUITE 2NE, ANN ARBOR, MI 48108-1186
- **Mailing address phone:** (734) 975-1743
- **Mailing address fax:** (734) 975-1754

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | 2901016548 | MI | Yes |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 08/22/2020