=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184424897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NADEEM M KHAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2353 S CUSTER RD STE 1
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48161-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-430-9133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2353 S CUSTER RD STE 1
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48161-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-430-9133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NADEEM KHAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 734-430-9133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------