Provider Demographics
NPI:1063826683
Name:KHANNA, MONISHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONISHA
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3584
Mailing Address - Country:US
Mailing Address - Phone:908-307-2549
Mailing Address - Fax:
Practice Address - Street 1:1451 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-3584
Practice Address - Country:US
Practice Address - Phone:540-432-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415751122300000X
CO00202599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist