Provider Demographics
NPI:1972989952
Name:KHAKWANI, TASADAQ KHAN (DDS)
Entity Type:Individual
Prefix:
First Name:TASADAQ
Middle Name:KHAN
Last Name:KHAKWANI
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 1:20614 EMILY RD
Mailing Address - Street 2:#42M
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1181
Mailing Address - Country:US
Mailing Address - Phone:551-655-8955
Mailing Address - Fax:
Practice Address - Street 1:4980 175TH PL
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1624
Practice Address - Country:US
Practice Address - Phone:551-655-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0587531223G0001X
261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health