Provider Demographics
NPI:1730159633
Name:KARANTH, CHETANA D (DDS)
Entity type:Individual
Prefix:DR
First Name:CHETANA
Middle Name:D
Last Name:KARANTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50364 LIVINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-6802
Mailing Address - Country:US
Mailing Address - Phone:248-476-4416
Mailing Address - Fax:
Practice Address - Street 1:33566 W 8 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5271
Practice Address - Country:US
Practice Address - Phone:248-476-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4818464Medicaid