Provider Demographics
NPI:1639872153
Name:KHALED DENTAL CORPORATION
Entity Type:Organization
Organization Name:KHALED DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,
Authorized Official - Phone:818-312-4530
Mailing Address - Street 1:9301 WILSHIRE BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6141
Mailing Address - Country:US
Mailing Address - Phone:310-278-3666
Mailing Address - Fax:
Practice Address - Street 1:9301 WILSHIRE BLVD STE 407
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6141
Practice Address - Country:US
Practice Address - Phone:310-278-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty