Provider Demographics
NPI:1154991040
Name:KHAN, USSAMA (DDS)
Entity type:Individual
Prefix:DR
First Name:USSAMA
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2306 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2527
Mailing Address - Country:US
Mailing Address - Phone:620-225-5154
Mailing Address - Fax:
Practice Address - Street 1:2306 1ST AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2527
Practice Address - Country:US
Practice Address - Phone:620-225-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist