Provider Demographics
NPI:1396807616
Name:KHAN, AKHLAQ
Entity type:Individual
Prefix:
First Name:AKHLAQ
Middle Name:
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 1:100 N GARVER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1712
Mailing Address - Country:US
Mailing Address - Phone:513-783-4770
Mailing Address - Fax:513-783-4162
Practice Address - Street 1:100 N GARVER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1712
Practice Address - Country:US
Practice Address - Phone:513-783-4770
Practice Address - Fax:513-783-4162
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0216421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice