Provider Demographics
NPI:1447512488
Name:KHEDHER, HAWAZIN (DMD)
Entity type:Individual
Prefix:
First Name:HAWAZIN
Middle Name:
Last Name:KHEDHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13525 KINGSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4133
Mailing Address - Country:US
Mailing Address - Phone:586-864-0124
Mailing Address - Fax:
Practice Address - Street 1:13525 KINGSVILLE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4133
Practice Address - Country:US
Practice Address - Phone:586-864-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist