New Troy Group Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

NEW TROY GROUP DENTAL PLLC

Doing business as

Square Lake Family Dentistry

Practice address

6053 Rochester Rd
Troy, MI 48085-1303

Phone

(248) 558-2785

NPI assigned

Feb 22, 2025

Last updated

Feb 22, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brandon Sam Khaddor, DDSNPI 1417649286

Title

Dentist/Partner

Phone

(586) 804-8118

Specialties & licenses 1

Addresses

Other names 1

• Square Lake Family Dentistry Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brandon Sam Khaddor, D.D.S.

  • General Practice Dentistry
  • New Haven, MI
  • NPI 1417649286
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740182400000",
    "number": "1245036953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6053 ROCHESTER RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851303",
            "telephone_number": "248-558-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6053 ROCHESTER RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851303",
            "telephone_number": "248-558-2785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW TROY GROUP DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-22",
        "last_updated": "2025-02-22",
        "certification_date": "2025-02-22",
        "status": "A",
        "authorized_official_last_name": "KHADDOR",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "SAM",
        "authorized_official_title_or_position": "DENTIST/PARTNER",
        "authorized_official_telephone_number": "586-804-8118",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Square Lake Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Troy, MI
• Providers in Troy, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.