Healthcare Provider Details

I. General information

NPI: 1073755187
Provider Name (Legal Business Name): KHURRAM ASHRAF KHAN BDS, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7523 STATE RD
CINCINNATI OH
45255-2438
US

IV. Provider business mailing address

7523 STATE RD
CINCINNATI OH
45255-2438
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-8989
  • Fax: 513-232-1405
Mailing address:
  • Phone: 513-232-8989
  • Fax: 513-232-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30-024373
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: