Provider Demographics
NPI:1154474922
Name:KHALIL, MUSTAFA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:A
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 1:20 HURLEY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2111
Mailing Address - Country:US
Mailing Address - Phone:617-491-1403
Mailing Address - Fax:617-491-5648
Practice Address - Street 1:20 HURLEY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-2111
Practice Address - Country:US
Practice Address - Phone:617-491-1403
Practice Address - Fax:617-491-5648
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist