Provider Demographics
NPI:1346894128
Name:KHAN, FAYEZ AZIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:FAYEZ
Middle Name:AZIR
Last Name: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 1:1318 DAVIE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3565
Mailing Address - Country:US
Mailing Address - Phone:704-871-1413
Mailing Address - Fax:704-871-0173
Practice Address - Street 1:1318 DAVIE AVE STE A
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3565
Practice Address - Country:US
Practice Address - Phone:704-871-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist