Individual
KHADIJAH ISMAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
21 QUITMAN ST, NEWARK, NJ 07103-4105
(973) 424-4329
(973) 824-2097
Mailing address
103 BORMAN AVE, AVENEL, NJ 07001-2106
(973) 979-6144
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02314800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0097829
—
NJ
05
—
0097837
—
NJ
05
—
0097845
—
NJ
Enumeration date
03/06/2007
Last updated
07/09/2007
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