Active NPI
Khanzi Roberts, RDH
- Dental Hygienist
- Detroit, MI
National Provider Identifier
1366201097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2902020690
- Practice address
- 4909 E Outer Dr
Detroit, MI 48234-3446 - Phone
- (313) 366-8000
- NPI assigned
- Mar 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2902020690 | MI | Primary |
Addresses
Primary practice location
4909 E Outer Dr
Detroit, MI 48234-3446
Mailing address
2875 Troy Center Dr Apt P-31
Troy, MI 48084-4758
Phone (816) 255-5334
Other practice location 1
21040 Greenfield Rd
Oak Park, MI 48237-3025
Phone (248) 967-6500
Other practice location 2
2888 W Grand Blvd
Detroit, MI 48202-2612
Phone (313) 875-4200
Other practice location 3
46156 Woodward Ave
Pontiac, MI 48342-5033
Phone (248) 897-0900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2902020690 | MI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710460800000",
"number": "1366201097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2875 TROY CENTER DR APT P-31",
"city": "TROY",
"state": "MI",
"postal_code": "480844758",
"telephone_number": "816-255-5334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4909 E OUTER DR",
"city": "DETROIT",
"state": "MI",
"postal_code": "482343446",
"telephone_number": "313-366-8000"
}
],
"practiceLocations": [
{
"address_1": "21040 Greenfield Rd",
"address_purpose": "LOCATION",
"city": "Oak Park",
"state": "MI",
"postal_code": "482373025",
"country_code": "US",
"telephone_number": "248-967-6500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2888 W Grand Blvd",
"address_purpose": "LOCATION",
"city": "Detroit",
"state": "MI",
"postal_code": "482022612",
"country_code": "US",
"telephone_number": "313-875-4200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "46156 Woodward Ave",
"address_purpose": "LOCATION",
"city": "Pontiac",
"state": "MI",
"postal_code": "483425033",
"country_code": "US",
"telephone_number": "248-897-0900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROBERTS",
"first_name": "KHANZI",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-15",
"last_updated": "2024-03-15",
"certification_date": "2024-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MI",
"license": "2902020690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.