Provider Demographics
NPI:1215195920
Name:KHAN, SHIZA N
Entity Type:Individual
Prefix:DR
First Name:SHIZA
Middle Name:N
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 S HURON RD,
Mailing Address - Street 2:UNIT 12
Mailing Address - City:GREENBAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311
Mailing Address - Country:US
Mailing Address - Phone:904-316-2672
Mailing Address - Fax:
Practice Address - Street 1:2851 UNIVERSITY AVENUE
Practice Address - Street 2:DENTAL DEPT, MILO C. HUEMPFNER VA HEALTH CARE CENTER
Practice Address - City:GREENBAY
Practice Address - State:WI
Practice Address - Zip Code:54311
Practice Address - Country:US
Practice Address - Phone:904-316-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089851223P0300X
IL019-0288271223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics