Provider Demographics
NPI:1225410079
Name:SHAH-KHAN, SARDAR MURTUZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARDAR
Middle Name:MURTUZA
Last Name:SHAH-KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 FAIRVIEW RD
Mailing Address - Street 2:STE 120
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3167
Mailing Address - Country:US
Mailing Address - Phone:704-523-1462
Mailing Address - Fax:704-525-9076
Practice Address - Street 1:5970 FAIRVIEW RD
Practice Address - Street 2:STE 120
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3167
Practice Address - Country:US
Practice Address - Phone:704-523-1462
Practice Address - Fax:704-525-9076
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist