Provider Demographics
NPI:1740269570
Name:KHAN, AMBER IMTIAZ (DMD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:IMTIAZ
Last Name:KHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 TOWN CTR BLVD
Mailing Address - Street 2:APT 201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6103
Mailing Address - Country:US
Mailing Address - Phone:407-240-1500
Mailing Address - Fax:407-240-6922
Practice Address - Street 1:3924 TOWN CTR BLVD
Practice Address - Street 2:APT 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6103
Practice Address - Country:US
Practice Address - Phone:407-240-1500
Practice Address - Fax:407-240-6922
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319-015482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist