Provider Demographics
NPI:1659632248
Name:KHALFANI WALKER, DMD, LLC
Entity Type:Organization
Organization Name:KHALFANI WALKER, DMD, LLC
Other - Org Name:ELITE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KHALFANI
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-622-0484
Mailing Address - Street 1:11175 GEORGIA AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11175 GEORGIA AVE
Practice Address - Street 2:UNIT A
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4605
Practice Address - Country:US
Practice Address - Phone:301-622-0484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1942468590OtherINDIVIDUAL NPI