Healthcare Provider Details

I. General information

NPI: 1144722794
Provider Name (Legal Business Name): ABDUL JABBAR KHAN DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N 10TH ST STE 204
SANGER TX
76266-4241
US

IV. Provider business mailing address

617 N 10TH ST STE 204
SANGER TX
76266-4241
US

V. Phone/Fax

Practice location:
  • Phone: 470-272-4607
  • Fax:
Mailing address:
  • Phone: 470-272-4607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number34664
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: