Healthcare Provider Details

I. General information

NPI: 1205333770
Provider Name (Legal Business Name): ANUM AHMED KHAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MAIN ST
STONEHAM MA
02180-3346
US

IV. Provider business mailing address

7 SEQUOIA DR
WILMINGTON MA
01887-2578
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-6520
  • Fax:
Mailing address:
  • Phone: 518-389-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1857982
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12850
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number35702
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901600557
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: