Provider Demographics
NPI:1700060548
Name:KHAN, MOONA NAUSHEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOONA
Middle Name:NAUSHEEN
Last Name:KHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MOONA
Other - Middle Name:NAUSHEEN
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8322 84TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5648
Mailing Address - Country:US
Mailing Address - Phone:715-781-3345
Mailing Address - Fax:
Practice Address - Street 1:3402 S 18TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1903
Practice Address - Country:US
Practice Address - Phone:715-781-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050859-11223G0001X
WADE000110221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice