Provider Demographics
NPI:1457515629
Name:KHOSLA, SANJEEV (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:
Last Name:KHOSLA
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 1:1111 GESSNER DR STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6041
Mailing Address - Country:US
Mailing Address - Phone:713-461-4747
Mailing Address - Fax:713-461-2039
Practice Address - Street 1:1111 GESSNER DR STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6041
Practice Address - Country:US
Practice Address - Phone:713-461-4747
Practice Address - Fax:713-461-2039
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist