Healthcare Provider Details

I. General information

NPI: 1942468590
Provider Name (Legal Business Name): KHALFANI DUME WALKER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 GEORGIA AVE STE A
WHEATON MD
20902-7638
US

IV. Provider business mailing address

11175 GEORGIA AVE STE A
WHEATON MD
20902-7638
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-5175
  • Fax: 301-933-5186
Mailing address:
  • Phone: 301-933-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14525
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number053671-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: