Active NPI
Alexander Khalil
- Dental Assistant
- Brookline, MA
National Provider Identifier
1417692187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- DA14036
- Practice address
- 1540 Beacon St
Brookline, MA 02446-2215 - Phone
- (781) 414-0495
- NPI assigned
- Apr 28, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | DA14036 | MA | Primary |
Addresses
Primary practice location
1540 Beacon St
Brookline, MA 02446-2215
Mailing address
238 Lenox St
Norwood, MA 02062-3435
Phone (781) 414-0495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DA14036 | Other | MA | MASSACHUSETTS BOARD OF DENTISTRY |
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 |
|---|---|---|---|
| DA14036 | MA | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651104000000",
"number": "1417692187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "238 LENOX ST",
"city": "NORWOOD",
"state": "MA",
"postal_code": "020623435",
"telephone_number": "781-414-0495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 BEACON ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462215",
"telephone_number": "781-414-0495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHALIL",
"first_name": "ALEXANDER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-28",
"last_updated": "2022-04-28",
"certification_date": "2022-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "MA",
"license": "DA14036",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSACHUSETTS BOARD OF DENTISTRY",
"identifier": "DA14036",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.