Individual
DR. KHALID HASSAN MUTAWALLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S,M.S
Contact information
Practice address
3625 COLLEGE AVE, BX1822, DAVIE, FL 33314-7724
(202) 560-3320
Mailing address
215 SE 8TH AVE, APT#1640, FORT LAUDERDALE, FL 33301-3644
(202) 560-3320
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN 20908
FL
Other
Enumeration date
11/10/2015
Last updated
09/10/2016
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