Provider Demographics
NPI:1891962957
Name:KHAN, ARIF A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARIF
Middle Name:A
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 NERGE RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3260
Mailing Address - Country:US
Mailing Address - Phone:847-895-0000
Mailing Address - Fax:847-895-0002
Practice Address - Street 1:1121 NERGE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3260
Practice Address - Country:US
Practice Address - Phone:847-895-0000
Practice Address - Fax:847-895-0002
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190254591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice