Provider Demographics
NPI:1548002223
Name:DABAJA, KHALIL FOUAD (DDS)
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:FOUAD
Last Name:DABAJA
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 1:6062 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2578
Mailing Address - Country:US
Mailing Address - Phone:313-289-5649
Mailing Address - Fax:
Practice Address - Street 1:6950 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4503
Practice Address - Country:US
Practice Address - Phone:313-584-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist