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General NPI Number Information
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NPI Number | 1073734612
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Entity Type | Individual
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Provider Name | ADEL S. KHALIL D.D.S., M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 2435 WEBSTER ST STE 200
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City | BERKELEY
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State | CA
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Zip | 94705-2050
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Country | US
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Telephone | 510-548-9114
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Fax | 510-548-8046
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Provider Business Mailing Address
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Address Line | 2435 WEBSTER ST STE 200
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City | BERKELEY
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State | CA
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Zip | 94705-2050
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Country | US
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Telephone | 510-548-9114
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Fax | 510-548-8046
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 59216
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2901018891
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 4301093272
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901018891
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License Number State | MI
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