Provider Demographics
NPI:1972238822
Name:KHALID, HIRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HIRA
Middle Name:
Last Name:KHALID
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 S 164TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3037
Mailing Address - Country:US
Mailing Address - Phone:206-359-0607
Mailing Address - Fax:
Practice Address - Street 1:23866 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6848
Practice Address - Country:US
Practice Address - Phone:206-359-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61323493122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist