Provider Demographics
NPI:1487826145
Name:KHAN, SUMRA SHAHIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUMRA
Middle Name:SHAHIN
Last Name:KHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CROSS ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1670
Mailing Address - Country:US
Mailing Address - Phone:978-717-5819
Mailing Address - Fax:978-717-5826
Practice Address - Street 1:39 CROSS ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1670
Practice Address - Country:US
Practice Address - Phone:978-717-5819
Practice Address - Fax:978-717-5826
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19089122300000X
MA1855555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist