Provider Demographics
NPI:1073659405
Name:KHAN, MUHAMMAD SHOAIB (DMD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SHOAIB
Last Name:KHAN
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 1:1614 W CENTRAL RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2490
Mailing Address - Country:US
Mailing Address - Phone:847-253-8598
Mailing Address - Fax:847-253-8598
Practice Address - Street 1:1614 W CENTRAL RD
Practice Address - Street 2:SUITE 111
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2490
Practice Address - Country:US
Practice Address - Phone:847-253-8598
Practice Address - Fax:847-253-8598
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0275001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice