Provider Demographics
NPI:1982047122
Name:KHAN, SARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 CHESTNUT ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4511
Mailing Address - Country:US
Mailing Address - Phone:610-660-5188
Mailing Address - Fax:
Practice Address - Street 1:1930 CHESTNUT ST APT 5F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4511
Practice Address - Country:US
Practice Address - Phone:610-660-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist