Provider Demographics
NPI:1871004804
Name:ALJABI, KHAYRI
Entity Type:Individual
Prefix:
First Name:KHAYRI
Middle Name:
Last Name:ALJABI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11875 EDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-3803
Mailing Address - Country:US
Mailing Address - Phone:317-556-7166
Mailing Address - Fax:
Practice Address - Street 1:6516 WESTHEIMER RD STE J
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5139
Practice Address - Country:US
Practice Address - Phone:714-571-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334231223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics