Provider Demographics
NPI:1821219981
Name:KHAN, MUNEEZA
Entity Type:Individual
Prefix:
First Name:MUNEEZA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11144 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:STE E8
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2646
Mailing Address - Country:US
Mailing Address - Phone:480-860-9700
Mailing Address - Fax:
Practice Address - Street 1:11144 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:STE E8
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2646
Practice Address - Country:US
Practice Address - Phone:480-860-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5564124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist