Provider Demographics
NPI:1053696096
Name:KRASNIQI, BARDHA (DMD)
Entity type:Individual
Prefix:MRS
First Name:BARDHA
Middle Name:
Last Name:KRASNIQI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:FATBARDHE
Other - Middle Name:
Other - Last Name:KRASNIQI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7559 36TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-7651
Mailing Address - Country:US
Mailing Address - Phone:616-229-7177
Mailing Address - Fax:
Practice Address - Street 1:7559 36TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-7651
Practice Address - Country:US
Practice Address - Phone:616-229-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2205122300000X, 1223D0001X
MI2901022551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health