Provider Demographics
NPI:1891470340
Name:KHAROUB, HANEEN (DMD)
Entity Type:Individual
Prefix:
First Name:HANEEN
Middle Name:
Last Name:KHAROUB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 MAPLE AVE APT 3102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7468
Mailing Address - Country:US
Mailing Address - Phone:516-262-8352
Mailing Address - Fax:
Practice Address - Street 1:404 N INTERSTATE 35 E STE 118
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1866
Practice Address - Country:US
Practice Address - Phone:972-223-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist