Healthcare Provider Details

I. General information

NPI: 1205018371
Provider Name (Legal Business Name): DR. GHALIA KAYALI KATRANJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 W BIG BEAVER RD BLDG F
TROY MI
48084-3525
US

IV. Provider business mailing address

1756 N TELEGRAPH RD
DEARBORN MI
48128-1271
US

V. Phone/Fax

Practice location:
  • Phone: 248-649-1975
  • Fax: 248-649-1975
Mailing address:
  • Phone: 313-563-6601
  • Fax: 313-563-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901015470
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901015470
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: