MEDICARE: DR. ZAINAB KAUSAR KHAN DMD

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	122300000X	Dentist	DN012571	GA

General Provider Information

NPI Number	:	1770970279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZAINAB KAUSAR KHAN DMD

Provider Business Mailing Address
First Line	:	3104 WALKERS FALLS WAY
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-9213
Country	:	US
Telephone Number	:	770-932-6911
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 WALKERS FALLS WAY
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-9213
Country	:	US
Telephone Number	:	770-932-6911
Fax Number	:

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

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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