Healthcare Provider Details

I. General information

NPI: 1932037298
Provider Name (Legal Business Name): L. KHALIL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6626 CARNELIAN ST
RANCHO CUCAMONGA CA
91701-4515
US

IV. Provider business mailing address

11687 MOUNT WAVERLY CT
RANCHO CUCAMONGA CA
91737-7904
US

V. Phone/Fax

Practice location:
  • Phone: 562-375-8441
  • Fax:
Mailing address:
  • Phone: 562-375-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LIDYA KHALIL
Title or Position: DOCTOR
Credential: DDS
Phone: 562-375-8441