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General NPI Number Information
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NPI Number | 1497295679
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Entity Type | Organization
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Legal Business Name | SKK DENTAL PLLC DBA LIBERTY DENTAL ARTS
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 2749 W RIDGE RD
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City | ROCHESTER
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State | NY
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Zip | 14626-3038
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Country | US
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Telephone | 585-343-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 2749 W RIDGE RD
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City | ROCHESTER
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State | NY
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Zip | 14626-3038
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Country | US
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Telephone | 585-343-2090
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SAMIR K KHALIL
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Credential | DDS
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Telephone | 585-434-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 042165
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License Number State | NY
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