Provider Demographics
NPI:1447805973
Name:KHAN, AQIB NAWAZ (DDS)
Entity Type:Individual
Prefix:
First Name:AQIB
Middle Name:NAWAZ
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:USA DENTAL ACTIVITY ATTN: CREDENTIALS
Mailing Address - Street 2:2901 CASSIDY RD
Mailing Address - City:FORT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79916
Mailing Address - Country:US
Mailing Address - Phone:915-742-5935
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL ACTIVITY
Practice Address - Street 2:2901 CASSIDY RD
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79916
Practice Address - Country:US
Practice Address - Phone:915-742-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist