MEDICARE: DR. MICHAEL KHANNA D.D.S

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	3354	NV

General Provider Information

NPI Number	:	1407905474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KHANNA D.D.S

Provider Business Mailing Address
First Line	:	712 SIR JAMES BRIDGE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-8645
Country	:	US
Telephone Number	:	702-731-5700
Fax Number	:	702-731-0803

Provider Business Practice Location Address
First Line	:	4408 S EASTERN AVE # 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7825
Country	:	US
Telephone Number	:	702-731-5700
Fax Number	:	700-731-0803

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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