Provider Demographics
NPI:1699091579
Name:KHAN, ASMA (DDS)
Entity type:Individual
Prefix:
First Name:ASMA
Middle Name:
Last Name:KHAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 WOOD HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9776
Mailing Address - Country:US
Mailing Address - Phone:646-234-1530
Mailing Address - Fax:
Practice Address - Street 1:155 TRADERS WAY STE 400
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4300
Practice Address - Country:US
Practice Address - Phone:912-913-0467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN123520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program