Provider Demographics
NPI:1922104686
Name:KHAMBATY, QAYYUM ABBAS (BDS)
Entity Type:Individual
Prefix:DR
First Name:QAYYUM
Middle Name:ABBAS
Last Name:KHAMBATY
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6037
Mailing Address - Country:US
Mailing Address - Phone:727-841-7711
Mailing Address - Fax:727-844-5822
Practice Address - Street 1:6333 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6037
Practice Address - Country:US
Practice Address - Phone:727-841-7711
Practice Address - Fax:727-844-5822
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 103231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice