Provider Demographics
NPI:1174680961
Name:SANI KHATAM & ANDERSON PC
Entity Type:Organization
Organization Name:SANI KHATAM & ANDERSON PC
Other - Org Name:BALA ORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANI KHATAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-667-7171
Mailing Address - Street 1:125 W CITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004
Mailing Address - Country:US
Mailing Address - Phone:610-667-7171
Mailing Address - Fax:610-667-5121
Practice Address - Street 1:125 W CITY AVENUE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004
Practice Address - Country:US
Practice Address - Phone:610-667-7171
Practice Address - Fax:610-667-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024444L122300000X
PADS026658L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty