Provider Demographics
NPI:1477681716
Name:KHATER, MAYADA SHOUKFEH
Entity Type:Individual
Prefix:DR
First Name:MAYADA
Middle Name:SHOUKFEH
Last Name:KHATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 79TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2852
Mailing Address - Country:US
Mailing Address - Phone:806-794-7171
Mailing Address - Fax:
Practice Address - Street 1:5255 79TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2852
Practice Address - Country:US
Practice Address - Phone:806-794-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist