Individual
MARYAM KHALILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS-PROSTHODONTIST
Contact information
Practice address
3223 N BROAD ST OFC 314, PHILADELPHIA, PA 19140-5007
(773) 807-9934
Mailing address
1180 RAYMOND BLVD APT 11C, NEWARK, NJ 07102-4120
(773) 807-9934
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401416303
VA
122300000X
Dentist
34590
TX
1223P0700X
Prosthodontics
Primary
RFD000033
PA
Other
Enumeration date
12/19/2019
Last updated
11/09/2022
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