Adel S. Khalil, D.D.S., M.D.
Individual provider Active NPI Dentist · Berkeley, CA
NPI 1073734612 · NPPES record last updated Oct 24, 2018
Key facts
- NPI
- 1073734612
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2901018891 (MI)
- Practice address
- 2435 Webster St Ste 200
Berkeley, CA 94705-2050 - Phone
- (510) 548-9114
- Fax
- (510) 548-8046
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 2, 2017 through Oct 2, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901018891 | MI | MD | Oral and Maxillofacial Surgery (Dentist) |
| 59216 | CA | MD | Pharmacist |
| 4301093272 | MI | MD | Plastic and Reconstructive Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Khalil DDS Apc | Oral and Maxillofacial Surgery | Past | Accepting new patients |
| Keith T. Nelson, DDS Inc | Dentist | Past | Accepting new patients |
| Adel Khalil D.D.S., M.D. P.C. | Oral and Maxillofacial Surgery | Past | Accepting new patients |
Interoperability endpoints
- akhalil160307@hisp.ehr.sutterhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 59216 | CA | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 2901018891 | MI | |
| Plastic and Reconstructive Surgery Physician | 2086S0122X | 4301093272 | MI | |
| Dentist | 122300000X | 2901018891 | MI | Yes |
Addresses
Primary practice location
2435 Webster St Ste 200
Berkeley, CA 94705-2050
Mailing address
2435 Webster St Ste 200
Berkeley, CA 94705-2050
Phone (510) 548-9114
Other practice location 1
419 San Pablo Ave
Albany, CA 94706-1124
Phone (510) 526-8000
Other practice location 2
3031 Telegraph Ave Ste 234
Berkeley, CA 94705-2053
Phone (510) 548-9114
Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.