Provider Demographics
NPI:1518102631
Name:KHAN, LUBNA (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:LUBNA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MONROE TPKE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1300
Mailing Address - Country:US
Mailing Address - Phone:203-590-3222
Mailing Address - Fax:203-590-3273
Practice Address - Street 1:126 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1300
Practice Address - Country:US
Practice Address - Phone:203-590-3222
Practice Address - Fax:203-590-3273
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT92011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1518102631Medicaid