Provider Demographics
NPI:1821582784
Name:KHAN, KAYLA MICHELLE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MICHELLE
Last Name:KHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:MICHELLE
Other - Last Name:COUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1096
Mailing Address - Street 2:221 N. 4TH AVENUE
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705
Mailing Address - Country:US
Mailing Address - Phone:706-695-8318
Mailing Address - Fax:706-695-7857
Practice Address - Street 1:221 N. 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705
Practice Address - Country:US
Practice Address - Phone:706-695-8318
Practice Address - Fax:706-695-7857
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist