Provider Demographics
NPI:1841687753
Name:CARL M. KHALID
Entity type:Organization
Organization Name:CARL M. KHALID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-465-8901
Mailing Address - Street 1:2054 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2128
Mailing Address - Country:US
Mailing Address - Phone:773-465-8901
Mailing Address - Fax:
Practice Address - Street 1:2915 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3402
Practice Address - Country:US
Practice Address - Phone:773-762-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190189631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty