Healthcare Provider Details

I. General information

NPI: 1386185445
Provider Name (Legal Business Name): KHAIRUNNISA QURAISHI DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37184 DEQUINDRE RD
STERLING HEIGHTS MI
48310-3536
US

IV. Provider business mailing address

37184 DEQUINDRE RD
STERLING HEIGHTS MI
48310-3536
US

V. Phone/Fax

Practice location:
  • Phone: 586-978-2042
  • Fax:
Mailing address:
  • Phone: 586-978-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: KHAIRUNNISA QURAISHI
Title or Position: DDS PC
Credential:
Phone: 586-978-2042