Individual
DR. MARYAM RUBY KISHTA-DERANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2815 S PENNSYLVANIA AVE, SUITE 203, LANSING, MI 48910-3496
(517) 272-4150
Mailing address
6633 WESTWOOD CT, WEST BLOOMFIELD, MI 48322-1371
(248) 408-3136
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901019672
MI
Other
Enumeration date
08/20/2007
Last updated
08/20/2007
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