Provider Demographics
NPI:1952563934
Name:KHANI, SARAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:KHANI
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 1:12455 VICTORIA GARDENS LN
Mailing Address - Street 2:SUITE 190
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-7530
Mailing Address - Country:US
Mailing Address - Phone:909-463-7100
Mailing Address - Fax:
Practice Address - Street 1:12455 VICTORIA GARDENS LN
Practice Address - Street 2:SUITE 190
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-7530
Practice Address - Country:US
Practice Address - Phone:909-463-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA605971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program