Healthcare Provider Details

I. General information

NPI: 1679041024
Provider Name (Legal Business Name): KHALED TAHA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2018
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7702 RESEDA ST
SUGAR LAND TX
77479-3581
US

IV. Provider business mailing address

7702 RESEDA ST
SUGAR LAND TX
77479-3581
US

V. Phone/Fax

Practice location:
  • Phone: 202-725-2160
  • Fax:
Mailing address:
  • Phone: 202-725-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401416409
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number35050
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: