Provider Demographics
NPI:1255040309
Name:DIMA G KHALIFE DDS PC
Entity type:Organization
Organization Name:DIMA G KHALIFE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-226-2700
Mailing Address - Street 1:41570 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5867
Mailing Address - Country:US
Mailing Address - Phone:586-226-2700
Mailing Address - Fax:586-226-4320
Practice Address - Street 1:41570 HAYES RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5867
Practice Address - Country:US
Practice Address - Phone:586-226-2700
Practice Address - Fax:586-226-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1447495635Medicaid