Provider Demographics
NPI:1831158344
Name:KHAN, FAUZIA (DDS)
Entity type:Individual
Prefix:
First Name:FAUZIA
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 1:8095 MACON RD
Mailing Address - Street 2:SUITE #109
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8500
Mailing Address - Country:US
Mailing Address - Phone:901-756-9150
Mailing Address - Fax:901-756-8696
Practice Address - Street 1:8095 MACON RD
Practice Address - Street 2:SUITE #109
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8500
Practice Address - Country:US
Practice Address - Phone:901-756-9150
Practice Address - Fax:901-756-8696
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN80961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice