Healthcare Provider Details

I. General information

NPI: 1245159425
Provider Name (Legal Business Name): NORI KHUDEEDA KHALAF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 PINE LAKE RD
LINCOLN NE
68516-6032
US

IV. Provider business mailing address

5874 N 21ST ST
LINCOLN NE
68521-5066
US

V. Phone/Fax

Practice location:
  • Phone: 402-466-9632
  • Fax:
Mailing address:
  • Phone: 402-805-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8250
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: