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General NPI Number Information
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NPI Number | 1821838657
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Entity Type | Individual
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Provider Name | MANJINDER KAUR KHAIRA
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Gender | Female
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 26500 W HURON RIVER DR
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City | FLAT ROCK
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State | MI
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Zip | 48134-1135
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Country | US
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Telephone | 815-748-2666
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Fax |
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Provider Business Mailing Address
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Address Line | 32750 CARDINAL LN
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City | WAYNE
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State | MI
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Zip | 48184-2559
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Country | US
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Telephone | 734-306-8444
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901602421
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.035110
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License Number State | IL
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