Provider Demographics
NPI:1578638375
Name:SHABANY, KHALED Y (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:Y
Last Name:SHABANY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2307
Mailing Address - Country:US
Mailing Address - Phone:314-878-2111
Mailing Address - Fax:314-878-7648
Practice Address - Street 1:443 N NEW BALLAS RD STE 244
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6800
Practice Address - Country:US
Practice Address - Phone:314-755-1542
Practice Address - Fax:314-755-1546
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020030371223G0001X, 1223P0300X
IL021.0019301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice