Provider Demographics
NPI:1316838535
Name:VENUGOPALAN, AKSHAYA
Entity type:Individual
Prefix:
First Name:AKSHAYA
Middle Name:
Last Name:VENUGOPALAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 WASHTENAW RD APT 2B
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1527
Mailing Address - Country:US
Mailing Address - Phone:248-678-9423
Mailing Address - Fax:
Practice Address - Street 1:2936 WASHTENAW RD APT 2B
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1527
Practice Address - Country:US
Practice Address - Phone:248-678-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist