Provider Demographics
NPI:1649808486
Name:KHARE, HENNA A (DDS)
Entity type:Individual
Prefix:
First Name:HENNA
Middle Name:A
Last Name:KHARE
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 1:5970 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3625
Mailing Address - Country:US
Mailing Address - Phone:763-528-0102
Mailing Address - Fax:
Practice Address - Street 1:5970 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3625
Practice Address - Country:US
Practice Address - Phone:734-224-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10575122300000X
MND14629122300000X
390200000X
MI2901601997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program