Active NPI
Faris Khalifa, DDS
- Prosthodontics
- Boston, MA
National Provider Identifier
1033771944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- DL14554
- Practice address
- 1 Kneeland Street
8TH Floor
Boston, MA 02111-1527 - Phone
- (617) 636-6678
- Fax
- (617) 636-6582
- NPI assigned
- Jul 1, 2019
- Reactivated
- May 19, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Prosthodontics | 1223P0700X | DL14554 | MA | Primary |
Addresses
Primary practice location
1 Kneeland Street
8TH Floor
Boston, MA 02111-1527
Mailing address
1 Kneeland Street
1419E
Boston, MA 02111-1527
Phone (617) 636-6505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DL14554 | MA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1033771944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 KNEELAND STREET",
"address_2": "1419E",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527",
"telephone_number": "617-636-6505",
"fax_number": "617-636-6582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KNEELAND STREET",
"address_2": "8TH FLOOR",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527",
"telephone_number": "617-636-6678",
"fax_number": "617-636-6582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHALIFA",
"first_name": "FARIS",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-01",
"last_updated": "2021-05-19",
"certification_date": "2021-05-19",
"deactivation_date": "2020-02-17",
"reactivation_date": "2021-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MA",
"license": "DL14554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.