Provider Demographics
NPI:1467591065
Name:KHAN, FAISAL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 W GRAND PKWY S STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5834
Mailing Address - Country:US
Mailing Address - Phone:832-222-8687
Mailing Address - Fax:832-222-8684
Practice Address - Street 1:7910 W GRAND PKWY S STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5834
Practice Address - Country:US
Practice Address - Phone:832-222-8687
Practice Address - Fax:832-222-8684
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0529571223G0001X
TX244461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202975308Medicaid