MEDICARE: LAILA KHALID DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	04363	NH

General Provider Information

NPI Number	:	1225540776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAILA KHALID DMD

Provider Business Mailing Address
First Line	:	33 DIGITAL DR
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03062-4577
Country	:	US
Telephone Number	:	978-412-5954
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 AMHERST ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1216
Country	:	US
Telephone Number	:	508-265-7890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	10/24/2017

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