Provider Demographics
NPI:1407689078
Name:KHAIRA, ARIANNA LUIZA (DMD)
Entity type:Individual
Prefix:DR
First Name:ARIANNA
Middle Name:LUIZA
Last Name:KHAIRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 PENNY ROYAL ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2971
Mailing Address - Country:US
Mailing Address - Phone:760-219-6653
Mailing Address - Fax:
Practice Address - Street 1:528 W BALDWIN RD UNIT B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3313
Practice Address - Country:US
Practice Address - Phone:850-215-0128
Practice Address - Fax:850-481-1976
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist