Provider Demographics
NPI:1952308199
Name:KHAN, IFTIKHAR ALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:IFTIKHAR
Middle Name:ALI
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 1:1434 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5400
Mailing Address - Country:US
Mailing Address - Phone:626-335-7989
Mailing Address - Fax:626-335-2089
Practice Address - Street 1:1434 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5400
Practice Address - Country:US
Practice Address - Phone:626-335-7989
Practice Address - Fax:626-335-2089
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice