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General NPI Number Information
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NPI Number | 1083669808
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Entity Type | Individual
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Provider Name | AHMED KHOCHT DDS
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | LOMA LINDA UNIVERSITY SCHOOL OF DENTISTRY 11092 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92350-0001
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Country | US
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Telephone | 909-558-4643
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Fax | 909-558-7959
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Provider Business Mailing Address
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Address Line | 26630 BARTON RD APT 2713
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City | REDLANDS
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State | CA
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Zip | 92373-4323
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Country | US
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Telephone | 706-631-5680
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 63142
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License Number State | CA
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