MEDICARE: DR. JOSEPH A KHALIL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401410715	VA
2	1223P0700X	Prosthodontics	0401410715	VA

General Provider Information

NPI Number	:	1174742589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH A KHALIL D.D.S.

Provider Business Mailing Address
First Line	:	1012 N HIGHLAND ST
Second Line	:	STE. 130B-S
City	:	ARLINGTON
State	:	VA
Zip	:	22201-2112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 N HIGHLAND ST
Second Line	:	STE. 130B-S
City	:	ARLINGTON
State	:	VA
Zip	:	22201-2112
Country	:	US
Telephone Number	:	703-841-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	04/04/2014

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