MEDICARE: SOUTH VIENNA FAMILY DENTAL, IRFAN KHAN DDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1215318761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH VIENNA FAMILY DENTAL, IRFAN KHAN DDS, LLC

Provider Business Mailing Address
First Line	:	8490 E NATIONAL RD
Second Line	:
City	:	SOUTH VIENNA
State	:	OH
Zip	:	45369-9707
Country	:	US
Telephone Number	:	937-568-3302
Fax Number	:	937-568-3304

Provider Business Practice Location Address
First Line	:	8490 E NATIONAL RD
Second Line	:
City	:	SOUTH VIENNA
State	:	OH
Zip	:	45369-9707
Country	:	US
Telephone Number	:	937-568-3302
Fax Number	:	937-568-3304

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IRFAN KHAN
Credential	:	DDS
Telephone Number	:	937-568-3302

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	06/10/2015

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