Provider Demographics
NPI:1053849372
Name:AL-ZUBI, KHALID M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:M
Last Name:AL-ZUBI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:KHALID
Other - Middle Name:M
Other - Last Name:ALZUBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11724 BLUE MOON AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2003
Mailing Address - Country:US
Mailing Address - Phone:405-921-8065
Mailing Address - Fax:
Practice Address - Street 1:7130 W HEFNER RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4502
Practice Address - Country:US
Practice Address - Phone:405-595-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK69171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice