Provider Demographics
NPI:1124431200
Name:JILANI, KHALID R (DMD)
Entity type:Individual
Prefix:DR
First Name:KHALID
Middle Name:R
Last Name:JILANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 LAS VEGAS BLVD N STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5870
Mailing Address - Country:US
Mailing Address - Phone:702-748-8244
Mailing Address - Fax:702-997-1223
Practice Address - Street 1:2668 LAS VEGAS BLVD N STE 101
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5870
Practice Address - Country:US
Practice Address - Phone:702-748-8244
Practice Address - Fax:702-997-1223
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64416122300000X
NV65041223E0200X, 1223P0300X, 1223P0700X, 1223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics
No1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100539380Medicaid