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General NPI Number Information
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NPI Number | 1205333770
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Entity Type | Individual
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Provider Name | ANUM AHMED KHAN DMD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 531 ELM ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4549
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Country | US
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Telephone | 518-389-8263
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Fax |
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Provider Business Mailing Address
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Address Line | 1475 TEXAS ST UNIT 2206
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City | HOUSTON
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State | TX
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Zip | 77002-3707
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Country | US
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Telephone | 518-389-8263
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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 | 2901600557
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License Number State | MI
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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 | 35702
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1857982
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12850
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License Number State | CT
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