Healthcare Provider Details

I. General information

NPI: 1245647668
Provider Name (Legal Business Name): ADIL KHEIRI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24929 GODDARD RD
TAYLOR MI
48180-3930
US

IV. Provider business mailing address

24929 GODDARD RD
TAYLOR MI
48180-3930
US

V. Phone/Fax

Practice location:
  • Phone: 734-947-3621
  • Fax: 734-947-3633
Mailing address:
  • Phone: 734-947-3621
  • Fax: 734-947-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021349
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: