Provider Demographics
NPI:1235572645
Name:SS KHALIL DMD A MISSOURI PC
Entity Type:Organization
Organization Name:SS KHALIL DMD A MISSOURI PC
Other - Org Name:MIDWEST SNORING MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-849-5555
Mailing Address - Street 1:18375 VENTURA BLVD
Mailing Address - Street 2:SUITE 452
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4218
Mailing Address - Country:US
Mailing Address - Phone:818-465-9480
Mailing Address - Fax:800-397-2166
Practice Address - Street 1:11222 TESSON FERRY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6963
Practice Address - Country:US
Practice Address - Phone:314-849-5555
Practice Address - Fax:314-675-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty