Provider Demographics
NPI:1629426283
Name:KHALID R JILANI DMD LIMITED
Entity Type:Organization
Organization Name:KHALID R JILANI DMD LIMITED
Other - Org Name:BONITA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:JILANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-748-8244
Mailing Address - Street 1:2668 LAS VEGAS BLVD N STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5870
Mailing Address - Country:US
Mailing Address - Phone:702-748-8244
Mailing Address - Fax:702-997-1223
Practice Address - Street 1:2668 LAS VEGAS BLVD N STE 101
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5870
Practice Address - Country:US
Practice Address - Phone:702-748-8244
Practice Address - Fax:702-997-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223E0200X, 1223P0300X, 1223P0700X, 1223S0112X
NV65041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100539380Medicaid