Provider Demographics
NPI:1255019295
Name:KHATOON, RUKHAIYA
Entity type:Individual
Prefix:DR
First Name:RUKHAIYA
Middle Name:
Last Name:KHATOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CRIMSON STONE DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-5221
Mailing Address - Country:US
Mailing Address - Phone:614-696-2345
Mailing Address - Fax:
Practice Address - Street 1:3501 CRIMSON STONE DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-5221
Practice Address - Country:US
Practice Address - Phone:614-696-2345
Practice Address - Fax:614-664-9667
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0272851223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice