Provider Demographics
NPI:1508182312
Name:AMARDEEP KHARA, DMD, PA
Entity Type:Organization
Organization Name:AMARDEEP KHARA, DMD, PA
Other - Org Name:DREAM SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-714-7570
Mailing Address - Street 1:1830 GARNER STATION BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-3643
Mailing Address - Country:US
Mailing Address - Phone:919-714-7570
Mailing Address - Fax:919-714-7477
Practice Address - Street 1:1830 GARNER STATION BOULEVARD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3643
Practice Address - Country:US
Practice Address - Phone:919-714-7570
Practice Address - Fax:919-714-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914405Medicaid