MEDICARE: KHAVIS LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1861102329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHAVIS LLC

Provider Business Mailing Address
First Line	:	4499 GROVELAND RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5596 MAYFIELD RD
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2921
Country	:	US
Telephone Number	:	440-442-8220
Fax Number	:

Authorized Official
Title or Position	:	STATUTORY AGENT/DENTIST
Name	:	RAFAEL KHAVIS
Credential	:	DDS
Telephone Number	:	917-822-4185

Provider Enumeration Date	:	11/24/2022
Last Update Date	:	11/24/2022

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Directions to “KHAVIS LLC ” Practice Location

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