=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598485906
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZAINAB FATIMA KHAN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2022
-----------------------------------------------------
Last Update Date | 08/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33966 W 8 MILE RD STE 104
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48335-5273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-306-8753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3540 FOUNTAIN CIR APT 211
-----------------------------------------------------
City | AUBURN HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48326-3899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-964-8103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901601530
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------