Healthcare Provider Details

I. General information

NPI: 1629426283
Provider Name (Legal Business Name): KHALID R JILANI DMD LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
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 Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6504
License Number StateNV

VIII. Authorized Official

Name: DR. KHALID JILANI
Title or Position: GENERAL DENTIST/MANAGER
Credential: DMD
Phone: 702-748-8244