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General NPI Number Information
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NPI Number | 1285314815
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Entity Type | Individual
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Provider Name | SHAHMIR AKBAR KHAN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 548 W TWINCOURT TRL
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8881
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Country | US
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Telephone | 904-901-4684
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Fax |
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Provider Business Mailing Address
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Address Line | W249N5245 EXECUTIVE DR STE 206
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City | SUSSEX
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State | WI
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Zip | 53089-4393
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Country | US
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Telephone |
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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 | 6001272
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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 | DN30021
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License Number State | FL
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