Prasanna Kumar Shivapuja, BDS,MDS,DDS,MS ORTHO

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

14629 Issued in MI

Practice address

25979 Kelly Rd
Roseville, MI 48066-4941

Phone

(586) 779-3440

Fax

(586) 779-0091

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710067095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25979 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664941",
            "telephone_number": "586-779-3440",
            "fax_number": "586-779-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25979 KELLY RD",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664941",
            "telephone_number": "586-779-3440",
            "fax_number": "586-779-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVAPUJA",
        "first_name": "PRASANNA",
        "middle_name": "KUMAR",
        "name_prefix": "Dr.",
        "credential": "BDS,MDS,DDS,MS ORTHO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MI",
            "license": "14629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reem Basim Shakir, MD
• Soliel Shakoor
• Philip Joseph Shalhoub, M.D.
• Seema S Sharma, MD
• Hannah Marie Sheppard, FNP
• Shores Podiatry Associates, P.C.
• Shores Podiatry Associates, P.C.
• Alok Shukla, M.D
• Fatima Siddiqui, D.D.S.
• Troy Silverthorn, DPT

• Orthodontics and Dentofacial Orthopedics Dentistry in Roseville, MI
• Providers in Roseville, MI by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.