Provider Demographics
NPI:1184710212
Name:KHALIL, MOHAMMAD MOHSIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:MOHSIN
Last Name:KHALIL
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 1:2002 E SAGINAW ST
Mailing Address - Street 2:SUITE #107E
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3143
Mailing Address - Country:US
Mailing Address - Phone:810-720-0611
Mailing Address - Fax:810-720-0613
Practice Address - Street 1:G3500 FLUSHING RD
Practice Address - Street 2:SUITE #107E
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4235
Practice Address - Country:US
Practice Address - Phone:810-720-0611
Practice Address - Fax:810-720-0613
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI177821223G0001X
MI176761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4469514Medicaid
MI4469505Medicaid