Provider Demographics
NPI:1629505417
Name:AHMAD KHAN DENTAL CORP.
Entity Type:Organization
Organization Name:AHMAD KHAN DENTAL CORP.
Other - Org Name:ISMILE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-378-9389
Mailing Address - Street 1:1530 W 6TH ST
Mailing Address - Street 2:SUITE 101-A
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1530 W 6TH ST
Practice Address - Street 2:SUITE 101-A
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2742
Practice Address - Country:US
Practice Address - Phone:949-378-9389
Practice Address - Fax:909-622-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty