Provider Demographics
NPI:1770080970
Name:KHALID, AATIQAH AAKIFAH (DMD)
Entity type:Individual
Prefix:
First Name:AATIQAH
Middle Name:AAKIFAH
Last Name:KHALID
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHATEAU MOUTON DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1902
Mailing Address - Country:US
Mailing Address - Phone:919-475-6920
Mailing Address - Fax:
Practice Address - Street 1:10964 RIVER RD
Practice Address - Street 2:
Practice Address - City:SAINT ROSE
Practice Address - State:LA
Practice Address - Zip Code:70087-3400
Practice Address - Country:US
Practice Address - Phone:504-469-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA69921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program