MEDICARE: L. KHALIL DENTAL CORPORATION

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

General Provider Information

NPI Number	:	1932037298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L. KHALIL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	11687 MOUNT WAVERLY CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91737-7904
Country	:	US
Telephone Number	:	562-375-8441
Fax Number	:

Provider Business Practice Location Address
First Line	:	6626 CARNELIAN ST
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-4515
Country	:	US
Telephone Number	:	562-375-8441
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	LIDYA KHALIL
Credential	:	DDS
Telephone Number	:	562-375-8441

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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Directions to “L. KHALIL DENTAL CORPORATION ” Practice Location

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