Provider Demographics
NPI:1770900243
Name:DR AMANJOT KHARA, DDS, PC
Entity type:Organization
Organization Name:DR AMANJOT KHARA, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-559-5808
Mailing Address - Street 1:6372 MECHANICSVILLE TPKE
Mailing Address - Street 2:#106
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4705
Mailing Address - Country:US
Mailing Address - Phone:804-559-5808
Mailing Address - Fax:804-559-9671
Practice Address - Street 1:6372 MECHANICSVILLE TPKE
Practice Address - Street 2:#106
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4705
Practice Address - Country:US
Practice Address - Phone:804-559-5808
Practice Address - Fax:804-559-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-23
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008652122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063524684Medicaid