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General NPI Number Information
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NPI Number | 1629505417
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Entity Type | Organization
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Legal Business Name | AHMAD KHAN DENTAL CORP.
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 1530 W 6TH ST SUITE 101-A
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City | CORONA
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State | CA
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Zip | 92882-2742
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Country | US
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Telephone | 949-378-9389
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Fax | 909-622-0550
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Provider Business Mailing Address
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Address Line | 1530 W 6TH ST SUITE 101-A
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City | CORONA
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State | CA
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Zip | 92882-2742
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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 | PRESIDENT
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Name | SHEHZAD KHAN
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Credential | DDS
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Telephone | 949-378-9389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 54611
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License Number State | CA
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