Provider Demographics
NPI:1215181334
Name:SELECT DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:SELECT DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUFIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-459-3200
Mailing Address - Street 1:47299 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3764
Mailing Address - Country:US
Mailing Address - Phone:734-459-3200
Mailing Address - Fax:734-459-1995
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019252261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental