Individual
DR. BABER NAZIR KHATIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
1849 NW KEARNEY ST STE 300, PORTLAND, OR 97209-1453
(503) 224-1371
(503) 224-0722
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D11193
OR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD196775
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D11193
DENTAL LICENSE
OR
01
—
MD196775
MEDICAL LICENSE
OR
Enumeration date
06/18/2010
Last updated
01/03/2020
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