Provider Demographics
NPI:1720349152
Name:JAIN, KHUSHBOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KHUSHBOO
Middle Name:
Last Name:JAIN
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 1:2010 JOHN ROLFE PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-8111
Mailing Address - Country:US
Mailing Address - Phone:804-750-1284
Mailing Address - Fax:804-215-3905
Practice Address - Street 1:2010 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-8111
Practice Address - Country:US
Practice Address - Phone:804-750-1284
Practice Address - Fax:804-215-3905
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist