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General NPI Number Information
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NPI Number | 1174680961
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Entity Type | Organization
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Legal Business Name | SANI KHATAM & ANDERSON PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 W CITY AVENUE
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 610-667-7171
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Fax | 610-667-5121
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Provider Business Mailing Address
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Address Line | 125 W CITY AVENUE
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 610-667-7171
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Fax | 610-667-5121
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Authorized Official
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Title or Position | OWNER
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Name | DR. BAHMAN SANI KHATAM
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Credential | DMD
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Telephone | 610-667-7171
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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 | DS026658L
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License Number State | PA
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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 | DS024444L
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License Number State | PA
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