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General NPI Number Information
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NPI Number | 1154463974
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Entity Type | Individual
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Provider Name | VAJAHAT YAR KHAN BDS
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 225 NE 28TH ST
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City | FORT WORTH
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State | TX
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Zip | 76164-7205
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Country | US
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Telephone | 817-624-0044
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Fax | 817-624-0041
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Provider Business Mailing Address
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Address Line | 6103 W MASTERS DR APT # 1214
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City | FORT WORTH
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State | TX
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Zip | 76137-6865
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Country | US
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Telephone | 713-992-2114
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 23077
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License Number State | TX
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