Provider Demographics
NPI:1649591918
Name:ELKHATIB, MOHAMMAD BASEM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:BASEM
Last Name:ELKHATIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W PADONIA RD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2226
Mailing Address - Country:US
Mailing Address - Phone:410-252-5455
Mailing Address - Fax:
Practice Address - Street 1:22 W PADONIA RD
Practice Address - Street 2:SUITE 232
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2226
Practice Address - Country:US
Practice Address - Phone:410-252-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0383371223G0001X
MD154461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice