Provider Demographics
NPI:1487774899
Name:RANGASWAMY, SUJAY KUMAR (BDS)
Entity type:Individual
Prefix:
First Name:SUJAY
Middle Name:KUMAR
Last Name:RANGASWAMY
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 WEST EISENHOWER PARKWAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103
Mailing Address - Country:US
Mailing Address - Phone:734-996-9966
Mailing Address - Fax:
Practice Address - Street 1:760 WEST EISENHOWER PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:734-996-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI165491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558463661OtherNPI TYPE 2