Brandon Sam Khaddor, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901601643 Issued in MI

Practice address

59041 Gratiot Ave
New Haven, MI 48048-2057

Phone

(586) 749-3333

NPI assigned

May 22, 2023

Last updated

Feb 25, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• K2 Dental Flint PLLC

  • General Practice Dentistry
  • Flint, MI
  • NPI 1962371195
  NPD Authorized official
• New Troy Group Dental PLLC

  dba Square Lake Family Dentistry

  • General Practice Dentistry
  • Troy, MI
  • NPI 1245036953
  Authorized official Same address or phone
• Plev Sag, PLC

  dba Aspen Dental

  • Dentist
  • Saginaw, MI
  • NPI 1891103040
  NPD (past)

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1417649286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2564 LORENZO DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483144515",
            "telephone_number": "586-804-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59041 GRATIOT AVE",
            "city": "NEW HAVEN",
            "state": "MI",
            "postal_code": "480482057",
            "telephone_number": "586-749-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHADDOR",
        "first_name": "BRANDON",
        "middle_name": "SAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-22",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901601643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Jakubus, M.A.
• Ashanni Jennings
• Aline Kalayjian, RD
• Candace Kasper, RD
• Cynthia Kendziuk, RN
• Robbon Kippen
• Lauren Koenig, NP
• Chandra Lowe, MSW
• Majestic Home Healthcare LLC.
• Stephanie Maldonado-Diaz

• General Practice Dentistry in New Haven, MI
• Providers in New Haven, 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 25, 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.