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General NPI Number Information
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NPI Number | 1407905474
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Entity Type | Individual
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Provider Name | MICHAEL KHANNA D.D.S
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4408 S EASTERN AVE # 200
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City | LAS VEGAS
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State | NV
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Zip | 89119-7825
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Country | US
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Telephone | 702-731-5700
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Fax | 700-731-0803
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Provider Business Mailing Address
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Address Line | 712 SIR JAMES BRIDGE WAY
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City | LAS VEGAS
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State | NV
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Zip | 89145-8645
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Country | US
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Telephone | 702-731-5700
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Fax | 702-731-0803
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3354
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License Number State | NV
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