Healthcare Provider Details

I. General information

NPI: 1093495079
Provider Name (Legal Business Name): MOHAMMAD HASEEB KHAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 BENJAMIN CENTER DR STE 103
TAMPA FL
33634-5262
US

IV. Provider business mailing address

260 LORD ST UNIT 328
BROOKFIELD WI
53045-3330
US

V. Phone/Fax

Practice location:
  • Phone: 813-288-1999
  • Fax:
Mailing address:
  • Phone: 786-531-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6001245
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: