Provider Demographics
NPI:1811132384
Name:HENDOUS, KHALED (DDS)
Entity type:Individual
Prefix:DR
First Name:KHALED
Middle Name:
Last Name:HENDOUS
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 1:1453 VICTORIA VILLAGE LN APT 2204
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5889
Mailing Address - Country:US
Mailing Address - Phone:718-877-1253
Mailing Address - Fax:
Practice Address - Street 1:696 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4977
Practice Address - Country:US
Practice Address - Phone:321-383-7828
Practice Address - Fax:321-383-4470
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 173431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice