Provider Demographics
NPI:1073736377
Name:HUSSEIN, KHALID MANSOUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:MANSOUR
Last Name:HUSSEIN
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 1:3900 FAIRFAX DRIVE
Mailing Address - Street 2:APT 224
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1662
Mailing Address - Country:US
Mailing Address - Phone:571-201-7416
Mailing Address - Fax:
Practice Address - Street 1:3900 FAIRFAX DRIVE
Practice Address - Street 2:APT 224
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1662
Practice Address - Country:US
Practice Address - Phone:571-201-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10004891223G0001X
VA04014115641223G0001X
NY05135311223G0001X
MD135761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice