Provider Demographics
NPI:1184763237
Name:CHOUDHARY, KHALID M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KHALID
Middle Name:M
Last Name:CHOUDHARY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11921 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:240-483-0775
Mailing Address - Fax:240-238-8626
Practice Address - Street 1:11921 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 407
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:240-483-0775
Practice Address - Fax:240-238-8626
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14382122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist