Provider Demographics
NPI:1457525032
Name:KHATIB, JAMAL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:F
Last Name:KHATIB
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 1:3513 MCCART AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-4600
Mailing Address - Country:US
Mailing Address - Phone:817-921-4646
Mailing Address - Fax:
Practice Address - Street 1:3513 MCCART AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-4600
Practice Address - Country:US
Practice Address - Phone:817-921-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist