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General NPI Number Information
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NPI Number | 1962266296
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Entity Type | Organization
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Legal Business Name | MOHD KHALAF DDS INC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 2520 DOUGLAS BLVD STE 140
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City | ROSEVILLE
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State | CA
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Zip | 95661-3993
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Country | US
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Telephone | 916-860-1661
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 DOUGLAS BLVD STE 140
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City | ROSEVILLE
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State | CA
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Zip | 95661-3993
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Country | US
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Telephone | 916-860-1661
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHD KHALAF
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Credential | DDS
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Telephone | 859-539-3427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number |
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License Number State |
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