Provider Demographics
NPI:1659615466
Name:KAHILL, DAN
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:KAHILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19123 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-4008
Mailing Address - Country:US
Mailing Address - Phone:313-362-2222
Mailing Address - Fax:313-362-2223
Practice Address - Street 1:19123 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4008
Practice Address - Country:US
Practice Address - Phone:313-362-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI148051223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental