Provider Demographics
NPI:1770632937
Name:KHANNA, RUPAM (DDS)
Entity Type:Individual
Prefix:
First Name:RUPAM
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 CROW CANYON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1368
Mailing Address - Country:US
Mailing Address - Phone:925-866-8422
Mailing Address - Fax:925-863-1007
Practice Address - Street 1:3160 CROW CANYON RD
Practice Address - Street 2:STE 100
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1368
Practice Address - Country:US
Practice Address - Phone:925-866-8422
Practice Address - Fax:925-863-1007
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist