Healthcare Provider Details

I. General information

NPI: 1013519701
Provider Name (Legal Business Name): SUNDAS KHAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 MAIN ST
BRIDGEPORT CT
06606-5302
US

IV. Provider business mailing address

16 QUAKER LN
WEST HARRISON NY
10604-1122
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-6437
  • Fax:
Mailing address:
  • Phone: 516-754-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12960
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: