Provider Demographics
NPI:1932770070
Name:KHOSLA, ANAMIKA REEYA (DDS)
Entity Type:Individual
Prefix:
First Name:ANAMIKA
Middle Name:REEYA
Last Name:KHOSLA
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 1:24911 LAGUNA EDGE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3923
Mailing Address - Country:US
Mailing Address - Phone:713-823-4216
Mailing Address - Fax:
Practice Address - Street 1:111 HULL ST APT 405
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4205
Practice Address - Country:US
Practice Address - Phone:713-823-4216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374291223G0001X
VA0401418362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37429OtherTEXAS LICENSE
IL019.033312OtherILLINOIS LICENSE
VA0401418362OtherVIRGINIA LICENSE