Healthcare Provider Details

I. General information

NPI: 1174453906
Provider Name (Legal Business Name): KHAN DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N CHURCH ST
ASHEBORO NC
27203-4701
US

IV. Provider business mailing address

417 N CHURCH ST
ASHEBORO NC
27203-4701
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-9115
  • Fax:
Mailing address:
  • Phone: 336-629-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SALAAR REHMAN KHAN
Title or Position: MEDICAL DIRECTOR
Credential: DDS
Phone: 336-629-9115