Khalid R Chaudry, DDS
Individual provider Active NPI Dentist · Liberty Township, OH
NPI 1831297134 · NPPES record last updated Oct 6, 2016
Key facts
- NPI
- 1831297134
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 30022036 (OH)
- Practice address
- 6450 Norfolk CT
Liberty Township, OH 45044-9051 - Phone
- (917) 815-6369
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30022036 | OH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Liberty Dental Care & Dentures-LLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30022036 | OH | Yes |
Addresses
Primary practice location
6450 Norfolk CT
Liberty Township, OH 45044-9051
Mailing address
6450 Norfolk CT
Liberty Township, OH 45044-9051
Phone (917) 815-6369
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 310994808057 | Other | OH | CARE SOURCE |
| 2525959 | Medicaid | OH |
Other providers in Liberty Township, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.