Provider Demographics
NPI:1013028513
Name:THAI, KHANH C (DMD)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:C
Last Name:THAI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BITTERN CT
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1633
Mailing Address - Country:US
Mailing Address - Phone:609-706-1161
Mailing Address - Fax:856-489-0844
Practice Address - Street 1:1 WHEATLEY BLVD BLDG K
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9622
Practice Address - Country:US
Practice Address - Phone:856-223-0041
Practice Address - Fax:856-223-0020
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018489001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice