Provider Demographics
NPI:1225151095
Name:AHMED, KHALID MANZOOR (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:MANZOOR
Last Name:AHMED
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12967 NORTHLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1111
Mailing Address - Country:US
Mailing Address - Phone:734-285-2900
Mailing Address - Fax:734-285-5863
Practice Address - Street 1:12967 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1111
Practice Address - Country:US
Practice Address - Phone:734-285-2900
Practice Address - Fax:734-285-5863
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics