Basic Information
| Provider Information | |||||||||
| NPI: | 1033557863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VODOPYANOV | ||||||||
| FirstName: | DMITRY | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | B1 208 TAUBMAN CENTER | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481085018 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | B1 208 TAUBMAN CENTER | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481085018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342326048 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2013 | ||||||||
| LastUpdateDate: | 06/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901021004 | MI | Y | Dental Providers | Dentist |
No ID Information.