Provider Demographics
NPI:1568861102
Name:KHAN, ADILA (DMD)
Entity Type:Individual
Prefix:
First Name:ADILA
Middle Name:
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 1:53 EAGLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1081
Mailing Address - Country:US
Mailing Address - Phone:585-287-1559
Mailing Address - Fax:
Practice Address - Street 1:1950 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5620
Practice Address - Country:US
Practice Address - Phone:585-461-4350
Practice Address - Fax:585-461-9365
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY058410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program