Provider Demographics
NPI:1336885482
Name:INCISOR ADVISOR LLC
Entity type:Organization
Organization Name:INCISOR ADVISOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:682-554-8563
Mailing Address - Street 1:3890 DAVIE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-2581
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3890 DAVIE RD STE 171
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-2579
Practice Address - Country:US
Practice Address - Phone:682-554-8563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty