Healthcare Provider Details

I. General information

NPI: 1912836974
Provider Name (Legal Business Name): MILAN NICO KHAZANA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 VINEYARD WAY STE 505
WEST GROVE PA
19390-8836
US

IV. Provider business mailing address

356 REDBUD LN
KENNETT SQUARE PA
19348-1584
US

V. Phone/Fax

Practice location:
  • Phone: 610-869-6055
  • Fax:
Mailing address:
  • Phone: 610-563-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045673
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: