=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023245909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAKINA QAYYUM KHAMBATY DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2009
-----------------------------------------------------
Last Update Date | 02/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 RANCH TRL STE 102
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75063-4880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-597-2227
-----------------------------------------------------
Fax | 972-597-2225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 RANCH TRL STE 102
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75063-4880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-597-2227
-----------------------------------------------------
Fax | 972-597-2225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN18689
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019.028499
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 29731
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------