Healthcare Provider Details

I. General information

NPI: 1629987078
Provider Name (Legal Business Name): DENTAL OFFICES OF DR SHIZA KHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 CHASE SIX BLVD
BOONSBORO MD
21713-2059
US

IV. Provider business mailing address

708 CHASE SIX BLVD
BOONSBORO MD
21713-2059
US

V. Phone/Fax

Practice location:
  • Phone: 301-432-4322
  • Fax: 301-432-4330
Mailing address:
  • Phone: 301-432-4322
  • Fax: 301-432-4330

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: SHIZA KHAN
Title or Position: OWNER
Credential: DDS
Phone: 301-432-4322