Pavan Kumar, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2901021992 Issued in MI

Practice address

2790 12 Mile Rd
Berkley, MI 48072-1630

Phone

(248) 439-0088

Fax

(248) 439-2900

NPI assigned

Jun 25, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595203200000",
    "number": "1316398902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 12 MILE RD",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480721630",
            "telephone_number": "248-439-0088",
            "fax_number": "248-439-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 12 MILE RD",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480721630",
            "telephone_number": "248-439-0088",
            "fax_number": "248-439-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUMAR",
        "first_name": "PAVAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-25",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesse C. Krakauer, MD
• Kevin R Krause, MD
• Olaf C Kroneman III, MD
• Ernest Krug
• Jenniferlyn Kryvicky, C.N.
• Makayla Lahr
• Cristiaan Klaas Landman, PT
• Richard William Larned, B.S., M.S., D.C.
• Chris Lattin, RRT
• Patricia Jean Laudenslager

• Dentist in Berkley, MI
• Providers in Berkley, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.