Provider Demographics
NPI:1851586184
Name:KHALIL, SHAHIR M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHIR
Middle Name:M
Last Name:KHALIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1392 HIGH ST
Mailing Address - Street 2:#210
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8257
Mailing Address - Country:US
Mailing Address - Phone:330-334-7645
Mailing Address - Fax:330-335-3233
Practice Address - Street 1:1392 HIGH ST
Practice Address - Street 2:#210
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8257
Practice Address - Country:US
Practice Address - Phone:330-334-7645
Practice Address - Fax:330-335-3233
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist