MEDICARE: KHALIL FOUAD DABAJA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901602232	MI

General Provider Information

NPI Number	:	1548002223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALIL FOUAD DABAJA DDS

Provider Business Mailing Address
First Line	:	6062 UNIVERSITY DR
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2578
Country	:	US
Telephone Number	:	313-289-5649
Fax Number	:

Provider Business Practice Location Address
First Line	:	6950 SCHAEFER RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-4503
Country	:	US
Telephone Number	:	313-584-3210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	06/16/2024

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