Provider Demographics
NPI:1194617928
Name:TADROUS KHALIL, AMIRA (DMD)
Entity type:Individual
Prefix:
First Name:AMIRA
Middle Name:
Last Name:TADROUS KHALIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:AMIRA
Other - Middle Name:
Other - Last Name:TADROUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:16543 VINTAGE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-1125
Mailing Address - Country:US
Mailing Address - Phone:818-967-4578
Mailing Address - Fax:
Practice Address - Street 1:6301 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2611
Practice Address - Country:US
Practice Address - Phone:818-787-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1117441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice