Individual
JAYKRISHNA P THAKKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5716 MICHIGAN AVE, DETROIT, MI 48210-3039
(313) 625-1470
Mailing address
5716 MICHIGAN AVE, DETROIT, MI 48210-3039
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901022457
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/28/2017
Last updated
10/10/2017
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