Provider Demographics
NPI:1639277890
Name:FLUSHING FAMILY DENTAL CARE PLLC
Entity Type:Organization
Organization Name:FLUSHING FAMILY DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMAN
Authorized Official - Middle Name:KHALED
Authorized Official - Last Name:SHUKAIRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-659-7800
Mailing Address - Street 1:323 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 1:323 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI018404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty