Provider Demographics
NPI:1164508099
Name:KHALIFE, MOUFIDA A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MOUFIDA
Middle Name:A
Last Name:KHALIFE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MOUFIDA
Other - Middle Name:MASRI
Other - Last Name:KHALIFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9075 STONE HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170
Mailing Address - Country:US
Mailing Address - Phone:734-459-3200
Mailing Address - Fax:
Practice Address - Street 1:47299 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3764
Practice Address - Country:US
Practice Address - Phone:734-459-3200
Practice Address - Fax:734-459-1995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1164508099Medicaid
1164508099Medicare NSC
MI1164508099Medicare UPIN
MI1164508099Medicare Oscar/Certification
MI1164508099Medicare PIN