Healthcare Provider Details

I. General information

NPI: 1780105320
Provider Name (Legal Business Name): NASER A KHAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HILLIARD ROME RD
COLUMBUS OH
43228-9544
US

IV. Provider business mailing address

4900 MILAN RD
SANDUSKY OH
44870-5842
US

V. Phone/Fax

Practice location:
  • Phone: 614-429-5179
  • Fax:
Mailing address:
  • Phone: 630-379-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025587
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: