Provider Demographics
NPI:1801279211
Name:AL KHAREEF, SADOON
Entity type:Individual
Prefix:
First Name:SADOON
Middle Name:
Last Name:AL KHAREEF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35819 EASTMONT DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3542
Mailing Address - Country:US
Mailing Address - Phone:586-718-8747
Mailing Address - Fax:586-264-4290
Practice Address - Street 1:35819 EASTMONT DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3542
Practice Address - Country:US
Practice Address - Phone:586-718-8747
Practice Address - Fax:586-264-4290
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist