Provider Demographics
NPI:1508192063
Name:KHANNA, ANKUSH AKSHAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANKUSH
Middle Name:AKSHAY
Last Name:KHANNA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 3RD AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5551
Mailing Address - Country:US
Mailing Address - Phone:267-975-4899
Mailing Address - Fax:
Practice Address - Street 1:60 3RD AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5551
Practice Address - Country:US
Practice Address - Phone:267-975-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054655-11223X0400X
NJ22DI024246001223X0400X
CT101221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics