Provider Demographics
NPI:1568990240
Name:KHANAFER, ABRAHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:KHANAFER
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 1:51263 PLYMOUTH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6392
Mailing Address - Country:US
Mailing Address - Phone:313-673-6767
Mailing Address - Fax:
Practice Address - Street 1:8133 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3518
Practice Address - Country:US
Practice Address - Phone:248-509-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist