Healthcare Provider Details

I. General information

NPI: 1194565614
Provider Name (Legal Business Name): FARAZ KHAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 BLOOMFIELD AVE # 1
NEWARK NJ
07104-1104
US

IV. Provider business mailing address

7 CYPRESS CT
CLINTON NJ
08809-2614
US

V. Phone/Fax

Practice location:
  • Phone: 973-435-8100
  • Fax:
Mailing address:
  • Phone: 908-305-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI03134300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: