MEDICARE: DR. KHALIL MJAHED DDS

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	1223G0001X	General Practice Dentistry	9511	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780021808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHALIL MJAHED DDS

Provider Business Mailing Address
First Line	:	1307 E FRANKLIN ST
Second Line	:	SUITE C
City	:	MONROE
State	:	NC
Zip	:	28112-5196
Country	:	US
Telephone Number	:	704-776-4278
Fax Number	:	704-776-4279

Provider Business Practice Location Address
First Line	:	1307 E FRANKLIN ST
Second Line	:	SUITE C
City	:	MONROE
State	:	NC
Zip	:	28112-5196
Country	:	US
Telephone Number	:	704-776-4278
Fax Number	:	704-776-4279

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

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	03/06/2017

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