MEDICARE: DR. KHALID R CHAUDRY 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	122300000X	Dentist	30022036	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	310994808057	OTHER	OH	CARE SOURCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831297134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHALID R CHAUDRY DDS

Provider Business Mailing Address
First Line	:	6450 NORFOLK CT
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9051
Country	:	US
Telephone Number	:	917-815-6369
Fax Number	:

Provider Business Practice Location Address
First Line	:	6450 NORFOLK CT
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9051
Country	:	US
Telephone Number	:	917-815-6369
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/06/2016

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