Provider Demographics
NPI:1578217444
Name:KHAN, RIAD KHALIL (DDS)
Entity Type:Individual
Prefix:
First Name:RIAD
Middle Name:KHALIL
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12119 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1813
Mailing Address - Country:US
Mailing Address - Phone:718-704-6043
Mailing Address - Fax:
Practice Address - Street 1:12119 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1813
Practice Address - Country:US
Practice Address - Phone:718-704-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program