Provider Demographics
NPI:1609534189
Name:KHANNA, ANSHU (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANSHU
Middle Name:
Last Name:KHANNA
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 1:3522 SUNCHASE LN APT 905
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3192
Mailing Address - Country:US
Mailing Address - Phone:346-256-5991
Mailing Address - Fax:
Practice Address - Street 1:3522 SUNCHASE LN APT 905
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3192
Practice Address - Country:US
Practice Address - Phone:346-256-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014177621223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice