Individual
DR. MARK I KHAIMOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
180 CENTRE ST, NUTLEY, NJ 07110-2828
(973) 798-2639
(973) 798-2640
Mailing address
180 CENTRE ST, NUTLEY, NJ 07110-2828
(973) 798-2639
(973) 798-2640
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2249201
NJ
Other
Enumeration date
12/13/2006
Last updated
07/18/2016
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