Provider Demographics
NPI:1780925222
Name:KHAN, FATIMA (DDS)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:KHAN
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 1:8630 FENTON STREET
Mailing Address - Street 2:1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:240-839-5811
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:9220 SPRINGHILL LN
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1203
Practice Address - Country:US
Practice Address - Phone:240-624-2278
Practice Address - Fax:240-624-2279
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL665122300000X
MD15607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD071797500Medicaid