Provider Demographics
NPI:1790898922
Name:KHAN, AJMAL H (DMD)
Entity Type:Individual
Prefix:
First Name:AJMAL
Middle Name:H
Last Name:KHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9126 ROTHBURY DR
Mailing Address - Street 2:
Mailing Address - City:MONTOGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886
Mailing Address - Country:US
Mailing Address - Phone:301-740-3955
Mailing Address - Fax:301-740-3978
Practice Address - Street 1:9126 ROTHBURY DR
Practice Address - Street 2:
Practice Address - City:MONTOGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886
Practice Address - Country:US
Practice Address - Phone:301-740-3955
Practice Address - Fax:301-740-3978
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD171886OtherUCCI DENTAL INS ID