Provider Demographics
NPI:1295101160
Name:SAJJAD, KHALID (DDS)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:SAJJAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 ROSEMONT LN
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-5770
Mailing Address - Country:US
Mailing Address - Phone:513-580-1011
Mailing Address - Fax:
Practice Address - Street 1:757 E 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5538
Practice Address - Country:US
Practice Address - Phone:219-513-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012404A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist