Provider Demographics
NPI:1992480610
Name:KHEMMORO, THOMAS MARK (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MARK
Last Name:KHEMMORO
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 1:3828 MYSTIC VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1437
Mailing Address - Country:US
Mailing Address - Phone:248-444-2617
Mailing Address - Fax:
Practice Address - Street 1:44968 FORD RD STE R
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2900
Practice Address - Country:US
Practice Address - Phone:734-386-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016018291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice