Provider Demographics
NPI:1063500148
Name:KHALIL, SAMIR K (DDS)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:K
Last Name:KHALIL
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 1:2749 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3038
Mailing Address - Country:US
Mailing Address - Phone:585-434-2090
Mailing Address - Fax:585-413-3295
Practice Address - Street 1:2749 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3038
Practice Address - Country:US
Practice Address - Phone:585-434-2090
Practice Address - Fax:585-413-3295
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042165-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist