Provider Demographics
NPI:1801509666
Name:METRO EAST PERIODONTICS, PLLC
Entity type:Organization
Organization Name:METRO EAST PERIODONTICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABANY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:618-258-1244
Mailing Address - Street 1:160 S BELLWOOD DR STE C
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2086
Mailing Address - Country:US
Mailing Address - Phone:618-258-1244
Mailing Address - Fax:
Practice Address - Street 1:160 S BELLWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2086
Practice Address - Country:US
Practice Address - Phone:618-258-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty