Provider Demographics
NPI:1336242452
Name:KHAN, ROBIN RENEE (DDS)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:KHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S 208TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-1810
Mailing Address - Country:US
Mailing Address - Phone:402-493-2112
Mailing Address - Fax:402-493-8399
Practice Address - Street 1:3631 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5211
Practice Address - Country:US
Practice Address - Phone:402-493-2112
Practice Address - Fax:402-493-8399
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE911804019OtherTAX ID NUMBER
NE6688450001Medicare NSC