MEDICARE: AZAM KHAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5361	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174506778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZAM KHAN DDS

Provider Business Mailing Address
First Line	:	1530 W COMMERCE CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-6015
Country	:	US
Telephone Number	:	520-770-2700
Fax Number	:	520-770-2799

Provider Business Practice Location Address
First Line	:	1530 W COMMERCE CT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-6015
Country	:	US
Telephone Number	:	520-770-2700
Fax Number	:	520-770-2799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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Directions to “ AZAM KHAN DDS” Practice Location

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