Provider Demographics
NPI:1033819248
Name:KHATTAK, SANABIL MANZOOR (DDS)
Entity type:Individual
Prefix:
First Name:SANABIL
Middle Name:MANZOOR
Last Name:KHATTAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PICCADILLY DR STE A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3526
Mailing Address - Country:US
Mailing Address - Phone:336-760-8700
Mailing Address - Fax:336-518-0415
Practice Address - Street 1:108 PICCADILLY DR STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3526
Practice Address - Country:US
Practice Address - Phone:336-760-8700
Practice Address - Fax:336-518-0415
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC139491223G0001X
GADN123112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist