Provider Demographics
NPI:1073175709
Name:KHAN, BILAL HUSSAIN
Entity type:Individual
Prefix:
First Name:BILAL
Middle Name:HUSSAIN
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 FOREST HILL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1802
Mailing Address - Country:US
Mailing Address - Phone:804-272-7040
Mailing Address - Fax:
Practice Address - Street 1:6750 FOREST HILL AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1802
Practice Address - Country:US
Practice Address - Phone:804-272-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014176311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics