Individual
JISHA TONY PANICKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6111 S CEDAR ST, LANSING, MI 48911-5714
(517) 393-3447
Mailing address
1854 S PENNFIELD LN, CANTON, MI 48188-2559
(408) 230-4878
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901602091
MI
Other
Enumeration date
04/01/2024
Last updated
07/12/2024
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