Provider Demographics
NPI:1427279850
Name:KHAN, FAIZUL T (DDS)
Entity type:Individual
Prefix:DR
First Name:FAIZUL
Middle Name:T
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2102
Mailing Address - Country:US
Mailing Address - Phone:973-684-5854
Mailing Address - Fax:973-684-1952
Practice Address - Street 1:305 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2102
Practice Address - Country:US
Practice Address - Phone:973-684-5854
Practice Address - Fax:973-684-1952
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 190091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6466206Medicaid