Provider Demographics
NPI:1013246107
Name:KHALIL, ELIAS G (DDS)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:G
Last Name:KHALIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ELIAS
Other - Middle Name:G
Other - Last Name:ABOU KHALIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 N POST OAK LN
Mailing Address - Street 2:# 9202
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-7766
Mailing Address - Country:US
Mailing Address - Phone:513-885-9311
Mailing Address - Fax:
Practice Address - Street 1:10603 FUQUA ST
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2630
Practice Address - Country:US
Practice Address - Phone:713-944-4901
Practice Address - Fax:713-944-4900
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250171223G0001X
AZD78941223G0001X
CA585751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice