Healthcare Provider Details

I. General information

NPI: 1508182312
Provider Name (Legal Business Name): AMARDEEP KHARA, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 GARNER STATION BOULEVARD
RALEIGH NC
27603-3643
US

IV. Provider business mailing address

1830 GARNER STATION BOULEVARD
RALEIGH NC
27603-3643
US

V. Phone/Fax

Practice location:
  • Phone: 919-714-7570
  • Fax: 919-714-7477
Mailing address:
  • Phone: 919-714-7570
  • Fax: 919-714-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8096
License Number StateNC

VIII. Authorized Official

Name: DR. TONY A KHARA
Title or Position: PRESIDENT
Credential: DMD
Phone: 919-714-7570