Provider Demographics
NPI:1801154497
Name:KHAN, NIKHAT P (DMDAEGD)
Entity type:Individual
Prefix:DR
First Name:NIKHAT
Middle Name:P
Last Name:KHAN
Suffix:
Gender:F
Credentials:DMDAEGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 MAIN ST
Mailing Address - Street 2:APT# 4
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2812
Mailing Address - Country:US
Mailing Address - Phone:607-339-8818
Mailing Address - Fax:
Practice Address - Street 1:441 MAIN ST
Practice Address - Street 2:APT# 4
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2812
Practice Address - Country:US
Practice Address - Phone:607-339-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0108731223G0001X
NJ22D1025265001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice