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General NPI Number Information
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NPI Number | 1952895252
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Entity Type | Individual
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Provider Name | FERAS AL KHATIB DMD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/24/2023
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Provider Practice Location Address
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Address Line | 2800 COLLEGE AVE
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City | ALTON
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State | IL
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Zip | 62002-4700
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Country | US
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Telephone | 618-774-7119
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Fax |
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Provider Business Mailing Address
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Address Line | 13009 BARRETT CROSSING CT
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City | SAINT LOUIS
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State | MO
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Zip | 63122-4900
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Country | US
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Telephone | 314-827-7508
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2018019635
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 01931749
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License Number State | IL
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