Provider Demographics
NPI:1386917607
Name:ABID, KHALDOON (DDS)
Entity type:Individual
Prefix:
First Name:KHALDOON
Middle Name:
Last Name:ABID
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 1:415 S AIRPORT DR
Mailing Address - Street 2:STE C
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5396
Mailing Address - Country:US
Mailing Address - Phone:956-375-2248
Mailing Address - Fax:956-375-2249
Practice Address - Street 1:415 S AIRPORT DR STE C
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5396
Practice Address - Country:US
Practice Address - Phone:956-375-2248
Practice Address - Fax:956-375-2249
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1386916076Medicaid