Healthcare Provider Details

I. General information

NPI: 1821219981
Provider Name (Legal Business Name): MUNEEZA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11144 N FRANK LLOYD WRIGHT BLVD STE E8
SCOTTSDALE AZ
85259-2646
US

IV. Provider business mailing address

11144 N FRANK LLOYD WRIGHT BLVD STE E8
SCOTTSDALE AZ
85259-2646
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-9700
  • Fax:
Mailing address:
  • Phone: 480-860-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5564
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: