Provider Demographics
NPI:1164994729
Name:KHALID, MAAHEEN
Entity Type:Individual
Prefix:
First Name:MAAHEEN
Middle Name:
Last Name:KHALID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAAHEEN
Other - Middle Name:
Other - Last Name:KHALID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1400 EL CAMINO VILLAGE DR APT 811
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3057
Mailing Address - Country:US
Mailing Address - Phone:310-561-6069
Mailing Address - Fax:
Practice Address - Street 1:7878 GATEWAY BLVD E STE 101
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1802
Practice Address - Country:US
Practice Address - Phone:915-595-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice