Provider Demographics
NPI:1417116633
Name:ASHOO KHANUJA DDS MD INC
Entity Type:Organization
Organization Name:ASHOO KHANUJA DDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHSOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANUJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:216-328-1234
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:SUITE #209
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2358
Mailing Address - Country:US
Mailing Address - Phone:216-328-1234
Mailing Address - Fax:216-328-1229
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE #209
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:216-328-1234
Practice Address - Fax:216-328-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP03361Medicare PIN