Provider Demographics
NPI:1417003450
Name:KHAN, AYESHA SIDDIQUA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:SIDDIQUA
Last Name:KHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N SAN JACINTO ST
Mailing Address - Street 2:P.O. BOX 1629
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2388
Mailing Address - Country:US
Mailing Address - Phone:254-694-8920
Mailing Address - Fax:254-694-0280
Practice Address - Street 1:200 N SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2388
Practice Address - Country:US
Practice Address - Phone:254-694-4428
Practice Address - Fax:254-694-0280
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice