Provider Demographics
NPI:1568691178
Name:KHAN, FARAH I (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARAH
Middle Name:I
Last Name:KHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:FARAH
Other - Middle Name:IQBAL
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:82 BRITTANY FARMS RD APT 231
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1246
Mailing Address - Country:US
Mailing Address - Phone:516-232-7609
Mailing Address - Fax:
Practice Address - Street 1:105 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051
Practice Address - Country:US
Practice Address - Phone:860-356-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist