Provider Demographics
NPI:1538290259
Name:SHUKAIRY, NIMAN KHALED (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIMAN
Middle Name:KHALED
Last Name:SHUKAIRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2033
Mailing Address - Country:US
Mailing Address - Phone:810-659-7800
Mailing Address - Fax:810-659-8706
Practice Address - Street 1:319 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2033
Practice Address - Country:US
Practice Address - Phone:810-659-7800
Practice Address - Fax:810-659-8706
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI018404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist