Provider Demographics
NPI:1912157199
Name:KHALIL & KINAIA D.D.S.,P.C.
Entity Type:Organization
Organization Name:KHALIL & KINAIA D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-720-0611
Mailing Address - Street 1:G3500 FLUSHING RD
Mailing Address - Street 2:STE 107E
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4235
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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI177821223G0001X
MI176761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty