Provider Demographics
NPI:1588440564
Name:KHAN, MUHAMMAD TAIMUR (BDS, MPH, MS)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:TAIMUR
Last Name:KHAN
Suffix:
Gender:M
Credentials:BDS, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7039 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1059
Mailing Address - Country:US
Mailing Address - Phone:708-956-7759
Mailing Address - Fax:
Practice Address - Street 1:7039 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1059
Practice Address - Country:US
Practice Address - Phone:708-956-7759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty