Healthcare Provider Details

I. General information

NPI: 1942554704
Provider Name (Legal Business Name): MOHAMMED-ABDUL KHAN, DDS, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 WASHINGTON RD SUITE # 562
MC MURRAY PA
15317-3063
US

IV. Provider business mailing address

3515 WASHINGTON RD SUITE # 562
MC MURRAY PA
15317-3063
US

V. Phone/Fax

Practice location:
  • Phone: 724-260-5184
  • Fax:
Mailing address:
  • Phone: 724-260-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS029596L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0077451000002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. MOHAMMED-ABDUL KHAN
Title or Position: OWNER
Credential: DDS, MD
Phone: 724-260-5184