MEDICARE: DR. LUBNA KHAN D.M.D., MDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9201	CT

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	:	1518102631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUBNA KHAN D.M.D., MDS

Provider Business Mailing Address
First Line	:	126 MONROE TPKE
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1300
Country	:	US
Telephone Number	:	203-590-3222
Fax Number	:	203-590-3273

Provider Business Practice Location Address
First Line	:	126 MONROE TPKE
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1300
Country	:	US
Telephone Number	:	203-590-3222
Fax Number	:	203-590-3273

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

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	02/26/2015

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