Healthcare Provider Details

I. General information

NPI: 1811818578
Provider Name (Legal Business Name): ANUM KHAN D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
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

61 MAIN ST
STONEHAM MA
02180-3346
US

V. Phone/Fax

Practice location:
  • Phone: 518-389-8263
  • 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 Number
License Number State

VIII. Authorized Official

Name: ANUM KHAN
Title or Position: DENTIST
Credential: DMD
Phone: 518-389-8263