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General NPI Number Information
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NPI Number | 1609534189
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Entity Type | Individual
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Provider Name | ANSHU KHANNA DMD
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Gender | Female
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 3522 SUNCHASE LN APT 905
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City | ROANOKE
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State | VA
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Zip | 24018-3192
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Country | US
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Telephone | 346-256-5991
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Fax |
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Provider Business Mailing Address
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Address Line | 3522 SUNCHASE LN APT 905
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City | ROANOKE
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State | VA
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Zip | 24018-3192
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Country | US
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Telephone | 346-256-5991
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401417762
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License Number State | VA
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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 | 0401417762
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License Number State | VA
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