Healthcare Provider Details

I. General information

NPI: 1144810011
Provider Name (Legal Business Name): ZENA KHORFAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N ASHLEY ST
ANN ARBOR MI
48103-3308
US

IV. Provider business mailing address

406 N ASHLEY ST
ANN ARBOR MI
48103-3308
US

V. Phone/Fax

Practice location:
  • Phone: 734-998-9640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.026356
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2951000875
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2951000875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: