Healthcare Provider Details

I. General information

NPI: 1215318761
Provider Name (Legal Business Name): SOUTH VIENNA FAMILY DENTAL, IRFAN KHAN DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8490 E NATIONAL RD
SOUTH VIENNA OH
45369-9707
US

IV. Provider business mailing address

8490 E NATIONAL RD
SOUTH VIENNA OH
45369-9707
US

V. Phone/Fax

Practice location:
  • Phone: 937-568-3302
  • Fax: 937-568-3304
Mailing address:
  • Phone: 937-568-3302
  • Fax: 937-568-3304

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. IRFAN KHAN
Title or Position: OWNER
Credential: DDS
Phone: 937-568-3302