Provider Demographics
NPI:1356662845
Name:KHATIB, BABER NAZIR (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:BABER
Middle Name:NAZIR
Last Name:KHATIB
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:1849 NW KEARNEY ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1453
Practice Address - Country:US
Practice Address - Phone:503-224-1371
Practice Address - Fax:503-224-0722
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD196775204E00000X
ORD111931223S0112X
SC1515204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD11193OtherDENTAL LICENSE
ORMD196775OtherMEDICAL LICENSE