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General NPI Number Information
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NPI Number | 1366201097
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Entity Type | Individual
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Provider Name | KHANZI ROBERTS RDH
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Gender | Female
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 4909 E OUTER DR
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City | DETROIT
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State | MI
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Zip | 48234-3446
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Country | US
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Telephone | 313-366-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 TROY CENTER DR APT P-31
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City | TROY
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State | MI
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Zip | 48084-4758
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Country | US
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Telephone | 816-255-5334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902020690
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License Number State | MI
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