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General NPI Number Information
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NPI Number | 1093495079
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Entity Type | Individual
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Provider Name | MOHAMMAD HASEEB KHAN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 5706 BENJAMIN CENTER DR STE 103
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City | TAMPA
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State | FL
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Zip | 33634-5262
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Country | US
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Telephone | 813-288-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 260 LORD ST UNIT 328
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City | BROOKFIELD
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State | WI
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Zip | 53045-3330
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Country | US
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Telephone | 786-531-2233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6001245
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN30140
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License Number State | FL
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