Provider Demographics
NPI:1073734612
Name:KHALIL, ADEL S (DDS, MD)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:S
Last Name:KHALIL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 WEBSTER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2050
Mailing Address - Country:US
Mailing Address - Phone:510-548-9114
Mailing Address - Fax:510-548-8046
Practice Address - Street 1:2435 WEBSTER ST STE 200
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2050
Practice Address - Country:US
Practice Address - Phone:510-548-9114
Practice Address - Fax:510-548-8046
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592161223S0112X
MI29010188911223S0112X, 122300000X
MI43010932722086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery