Provider Demographics
NPI:1689062960
Name:DRS. KHATIB & KHATIB, DDS, PC
Entity Type:Organization
Organization Name:DRS. KHATIB & KHATIB, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-921-4646
Mailing Address - Street 1:3513 MCCART AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-4600
Mailing Address - Country:US
Mailing Address - Phone:817-921-4646
Mailing Address - Fax:817-921-4546
Practice Address - Street 1:3513 MCCART AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-4600
Practice Address - Country:US
Practice Address - Phone:817-921-4646
Practice Address - Fax:817-921-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21722122300000X
TX23286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194372201Medicaid
TX167065501Medicaid