Provider Demographics
NPI:1861521221
Name:KHALIL, ALBERT ATALLA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ATALLA
Last Name:KHALIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 KAMM AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2126
Mailing Address - Country:US
Mailing Address - Phone:732-257-4749
Mailing Address - Fax:732-257-6245
Practice Address - Street 1:29 KAMM AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-2126
Practice Address - Country:US
Practice Address - Phone:732-257-4749
Practice Address - Fax:732-257-6245
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019430001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice