Healthcare Provider Details

I. General information

NPI: 1508464579
Provider Name (Legal Business Name): KHAN DENTAL-ALUM CREEK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 ALUM CREEK DR
COLUMBUS OH
43207-5137
US

IV. Provider business mailing address

830 BETHESDA DR
ZANESVILLE OH
43701-1895
US

V. Phone/Fax

Practice location:
  • Phone: 614-409-9404
  • Fax:
Mailing address:
  • Phone: 740-454-9961
  • Fax: 740-454-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ADEEL KHAN
Title or Position: OWNER
Credential: D.D.S.
Phone: 740-454-9961