Provider Demographics
NPI:1255945002
Name:KHAMIS, SHANA K (DDS)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:K
Last Name:KHAMIS
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 1:9617 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1203
Mailing Address - Country:US
Mailing Address - Phone:847-542-9316
Mailing Address - Fax:
Practice Address - Street 1:2001 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2471
Practice Address - Country:US
Practice Address - Phone:602-249-9621
Practice Address - Fax:602-841-1916
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0108521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice