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General NPI Number Information
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NPI Number | 1417614785
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Entity Type | Individual
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Provider Name | DR. MARIA QASIM KHAN
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Gender | Female
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 36420 DOMINION CIR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-7459
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Country | US
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Telephone | 586-489-9467
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Fax |
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Provider Business Mailing Address
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Address Line | 36420 DOMINION CIR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-7459
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Country | US
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Telephone |
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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 | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number | 37980
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License Number State | TX
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