Healthcare Provider Details

I. General information

NPI: 1184424897
Provider Name (Legal Business Name): NADEEM M KHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 S CUSTER RD STE 1
MONROE MI
48161-5047
US

IV. Provider business mailing address

2353 S CUSTER RD STE 1
MONROE MI
48161-5047
US

V. Phone/Fax

Practice location:
  • Phone: 734-430-9133
  • Fax:
Mailing address:
  • Phone: 734-430-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NADEEM KHAN
Title or Position: OWNER
Credential: DDS
Phone: 734-430-9133