Provider Demographics
NPI:1851504773
Name:KHATTAK, RANA ANJUM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANA
Middle Name:ANJUM
Last Name:KHATTAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RANA
Other - Middle Name:ANJUM
Other - Last Name:MUNEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2601 PRINCESS ANNE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3254
Mailing Address - Country:US
Mailing Address - Phone:540-373-0711
Mailing Address - Fax:540-371-7871
Practice Address - Street 1:2601 PRINCESS ANNE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3254
Practice Address - Country:US
Practice Address - Phone:540-373-0711
Practice Address - Fax:540-371-7871
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist