Provider Demographics
NPI:1871647040
Name:KHAN, FARAH S (DMD)
Entity Type:Individual
Prefix:DR
First Name:FARAH
Middle Name:S
Last Name:KHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5043 BRENDLYNN DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7657
Mailing Address - Country:US
Mailing Address - Phone:678-939-5943
Mailing Address - Fax:
Practice Address - Street 1:350 TOWN CENTER AVE
Practice Address - Street 2:301
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-835-0793
Practice Address - Fax:678-546-7932
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice