Provider Demographics
NPI:1114576402
Name:KHANNA, AVANIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AVANIKA
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AVANIKA
Other - Middle Name:KHANNA
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8309 HIGHGATE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 W HIGHWAY 199 STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-2611
Practice Address - Country:US
Practice Address - Phone:682-238-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL243521223G0001X
TX393031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice