Provider Demographics
NPI:1457523755
Name:JEEVAKA YAPA DDS PC
Entity type:Organization
Organization Name:JEEVAKA YAPA DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LAVONE
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-262-9100
Mailing Address - Street 1:29425 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1080
Mailing Address - Country:US
Mailing Address - Phone:248-262-9100
Mailing Address - Fax:248-262-9104
Practice Address - Street 1:29425 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 330
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1080
Practice Address - Country:US
Practice Address - Phone:248-262-9100
Practice Address - Fax:248-262-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16026261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12 3259450Medicaid
MIU62192Medicare UPIN
MI12 3259450Medicaid