Provider Demographics
NPI:1205333770
Name:KHAN, ANUM AHMED (DMD)
Entity type:Individual
Prefix:
First Name:ANUM
Middle Name:AHMED
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 1:1475 TEXAS ST UNIT 2206
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-3707
Mailing Address - Country:US
Mailing Address - Phone:518-389-8263
Mailing Address - Fax:
Practice Address - Street 1:531 ELM ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4549
Practice Address - Country:US
Practice Address - Phone:518-389-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600557122300000X
TX35702122300000X
MADN1857982122300000X
390200000X
CT128501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program