Provider Demographics
NPI:1144606591
Name:KHAN, FATIMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 TWIN BUTTES DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7226
Mailing Address - Country:US
Mailing Address - Phone:954-464-6324
Mailing Address - Fax:
Practice Address - Street 1:811 TWIN BUTTES DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7226
Practice Address - Country:US
Practice Address - Phone:954-464-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist