Healthcare Provider Details

I. General information

NPI: 1124431200
Provider Name (Legal Business Name): KHALID R JILANI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2668 LAS VEGAS BLVD N STE 101
NORTH LAS VEGAS NV
89030-5870
US

IV. Provider business mailing address

2668 LAS VEGAS BLVD N STE 101
NORTH LAS VEGAS NV
89030-5870
US

V. Phone/Fax

Practice location:
  • Phone: 702-748-8244
  • Fax: 702-997-1223
Mailing address:
  • Phone: 702-748-8244
  • Fax: 702-997-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number64416
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6504
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6504
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number6504
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6504
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6504
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: