Provider Demographics
NPI:1265919286
Name:KHALID, ISMA
Entity type:Individual
Prefix:
First Name:ISMA
Middle Name:
Last Name:KHALID
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ISMA
Other - Middle Name:
Other - Last Name:KHALID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BDS
Mailing Address - Street 1:36 THOMAS INDIAN SCHOOL DRIVE
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081-9300
Mailing Address - Country:US
Mailing Address - Phone:716-532-5582
Mailing Address - Fax:716-242-6344
Practice Address - Street 1:6729 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-3522
Practice Address - Country:US
Practice Address - Phone:713-325-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01339771223P0221X
TX368871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry