Provider Demographics
NPI:1891982443
Name:KHALIFA, EMAD GUS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:GUS
Last Name:KHALIFA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20950 N TATUM BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4268
Mailing Address - Country:US
Mailing Address - Phone:480-538-8100
Mailing Address - Fax:480-535-8101
Practice Address - Street 1:20950 N TATUM BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4268
Practice Address - Country:US
Practice Address - Phone:480-538-8100
Practice Address - Fax:480-535-8101
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics