Provider Demographics
NPI:1164032413
Name:KHOKHAR, QURRATULANN TALAT (DMD)
Entity type:Individual
Prefix:DR
First Name:QURRATULANN
Middle Name:TALAT
Last Name:KHOKHAR
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 1:4425 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2863
Mailing Address - Country:US
Mailing Address - Phone:234-458-8088
Mailing Address - Fax:
Practice Address - Street 1:4425 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2863
Practice Address - Country:US
Practice Address - Phone:234-458-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0262681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice