Provider Demographics
NPI:1720408842
Name:KHAN, NADIYA
Entity Type:Individual
Prefix:
First Name:NADIYA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NADIYA
Other - Middle Name:
Other - Last Name:POPOVYCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1440 MASOMA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1427
Mailing Address - Country:US
Mailing Address - Phone:732-668-7696
Mailing Address - Fax:
Practice Address - Street 1:2425 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-5228
Practice Address - Country:US
Practice Address - Phone:609-818-0300
Practice Address - Fax:609-818-0500
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025876001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice