Provider Demographics
NPI:1396885851
Name:KHANUJA, ASHOO (DDS MD)
Entity type:Individual
Prefix:
First Name:ASHOO
Middle Name:
Last Name:KHANUJA
Suffix:
Gender:F
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:SUITE #209
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2358
Mailing Address - Country:US
Mailing Address - Phone:216-328-1234
Mailing Address - Fax:216-328-1229
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE #209
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:216-328-1234
Practice Address - Fax:216-328-1229
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21566122300000X
OH35076890K1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH23321400Medicaid
OH23321400Medicaid
H55313Medicare UPIN