Provider Demographics
NPI:1275621898
Name:KHALIL-DOUEDI, MAGDA (DMD)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:
Last Name:KHALIL-DOUEDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 CHARLTON CIR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1481
Mailing Address - Country:US
Mailing Address - Phone:732-505-1190
Mailing Address - Fax:
Practice Address - Street 1:437 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7378
Practice Address - Country:US
Practice Address - Phone:732-505-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI170011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice