Provider Demographics
NPI:1154463974
Name:YAR KHAN, VAJAHAT (BDS)
Entity Type:Individual
Prefix:DR
First Name:VAJAHAT
Middle Name:
Last Name:YAR KHAN
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 W MASTERS DR
Mailing Address - Street 2:APT # 1214
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6865
Mailing Address - Country:US
Mailing Address - Phone:713-992-2114
Mailing Address - Fax:
Practice Address - Street 1:225 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-7205
Practice Address - Country:US
Practice Address - Phone:817-624-0044
Practice Address - Fax:817-624-0041
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1826141Medicaid