Provider Demographics
NPI:1134323587
Name:KHANNA, RISHI RAJ (DMD)
Entity Type:Individual
Prefix:DR
First Name:RISHI
Middle Name:RAJ
Last Name:KHANNA
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 1:4645 SWEETWATER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3016
Mailing Address - Country:US
Mailing Address - Phone:857-540-1642
Mailing Address - Fax:
Practice Address - Street 1:4645 SWEETWATER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3016
Practice Address - Country:US
Practice Address - Phone:857-540-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0206156Medicare ID - Type UnspecifiedMASS HEALTH DENTAL