Healthcare Provider Details

I. General information

NPI: 1043136674
Provider Name (Legal Business Name): KAUSAR KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 DAGGETT DR STE 1C
WEST SPRINGFIELD MA
01089-4646
US

IV. Provider business mailing address

21 MIRABEL CT
BLOOMFIELD CT
06002-1900
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-6906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001373
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: