Provider Demographics
NPI:1578297453
Name:KHATTAB, NADIR O (DDS)
Entity Type:Individual
Prefix:DR
First Name:NADIR
Middle Name:O
Last Name:KHATTAB
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 1:164 W HOSPITALITY LN STE 14
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3329
Mailing Address - Country:US
Mailing Address - Phone:951-463-1895
Mailing Address - Fax:
Practice Address - Street 1:164 W HOSPITALITY LN STE 14
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3329
Practice Address - Country:US
Practice Address - Phone:909-888-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist