Basic Information
| Provider Information | |||||||||
| NPI: | 1609322965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOY | ||||||||
| FirstName: | REJU | ||||||||
| MiddleName: | PALAKATT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481081633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060305831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792207 | ||||||||
| FaxNumber: | 8606791363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2901021812 | MI | N | Dental Providers | Dentist | General Practice | 1223S0112X | 2901021812 | MI | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 390200000X | 2901021812 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1223S0112X | 13058 | CT | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.