Healthcare Provider Details

I. General information

NPI: 1912157199
Provider Name (Legal Business Name): KHALIL & KINAIA D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3500 FLUSHING RD STE 107E
FLINT MI
48504-4235
US

IV. Provider business mailing address

G3500 FLUSHING RD STE 107E
FLINT MI
48504-4235
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-0611
  • Fax: 810-720-0613
Mailing address:
  • Phone: 810-720-0611
  • Fax: 810-720-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17676
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17782
License Number StateMI

VIII. Authorized Official

Name: MOHAMMAD M KHALIL
Title or Position: PRESIDENT
Credential:
Phone: 810-720-0611