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General NPI Number Information
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NPI Number | 1891982443
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Entity Type | Individual
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Provider Name | EMAD GUS KHALIFA D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 20950 N TATUM BLVD STE 210
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City | PHOENIX
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State | AZ
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Zip | 85050-4268
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Country | US
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Telephone | 480-538-8100
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Fax | 480-535-8101
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Provider Business Mailing Address
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Address Line | 20950 N TATUM BLVD STE 210
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City | PHOENIX
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State | AZ
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Zip | 85050-4268
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Country | US
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Telephone | 480-538-8100
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Fax | 480-535-8101
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 6338
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License Number State | AZ
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