Provider Demographics
NPI:1437513223
Name:HUSSEIN, KHALED (DDS)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:HUSSEIN
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 1:17 51ST STREET
Mailing Address - Street 2:APT 34
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086
Mailing Address - Country:US
Mailing Address - Phone:718-249-3107
Mailing Address - Fax:
Practice Address - Street 1:4 HASTINGS PL
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1805
Practice Address - Country:US
Practice Address - Phone:718-249-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI026869001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program