Healthcare Provider Details

I. General information

NPI: 1518402726
Provider Name (Legal Business Name): DANA AL KHATIB DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 N ACADEMY BLVD
COLORADO SPRINGS CO
80909-8307
US

IV. Provider business mailing address

2221 E BIJOU ST STE 100
COLORADO SPRINGS CO
80909-8009
US

V. Phone/Fax

Practice location:
  • Phone: 719-442-0071
  • Fax: 719-473-5303
Mailing address:
  • Phone: 719-576-1850
  • Fax: 719-955-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00203055
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: