Provider Demographics
NPI:1073703468
Name:AL-KHALAYLEH, MOSHEER (DDS)
Entity Type:Individual
Prefix:
First Name:MOSHEER
Middle Name:
Last Name:AL-KHALAYLEH
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 1:201 CHINA GRADE LOOP
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1707
Mailing Address - Country:US
Mailing Address - Phone:661-393-4333
Mailing Address - Fax:661-393-4343
Practice Address - Street 1:1830 28TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1904
Practice Address - Country:US
Practice Address - Phone:661-326-8536
Practice Address - Fax:661-326-8511
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47836Medicaid