Provider Demographics
NPI:1841570017
Name:KHAN, MASHAL (DDS)
Entity Type:Individual
Prefix:
First Name:MASHAL
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 SAINT MARTINS CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2549
Mailing Address - Country:US
Mailing Address - Phone:248-298-6934
Mailing Address - Fax:
Practice Address - Street 1:300 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4218
Practice Address - Country:US
Practice Address - Phone:248-585-5227
Practice Address - Fax:248-585-6358
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist