Provider Demographics
NPI:1942554704
Name:MOHAMMED-ABDUL KHAN, DDS, MD, LLC
Entity Type:Organization
Organization Name:MOHAMMED-ABDUL KHAN, DDS, MD, LLC
Other - Org Name:THREE RIVERS ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED-ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:724-260-5184
Mailing Address - Street 1:3515 WASHINGTON RD
Mailing Address - Street 2:SUITE # 562
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3063
Mailing Address - Country:US
Mailing Address - Phone:724-260-5184
Mailing Address - Fax:
Practice Address - Street 1:3515 WASHINGTON RD
Practice Address - Street 2:SUITE # 562
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3063
Practice Address - Country:US
Practice Address - Phone:724-260-5184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029596L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0077451000002Medicaid