Provider Demographics
NPI:1366321747
Name:ALKHEN, BUSHRA
Entity type:Individual
Prefix:
First Name:BUSHRA
Middle Name:
Last Name:ALKHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 SKYWAY DR APT 6208
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0051
Mailing Address - Country:US
Mailing Address - Phone:626-524-0009
Mailing Address - Fax:
Practice Address - Street 1:4929 SKYWAY DR APT 6208
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-0051
Practice Address - Country:US
Practice Address - Phone:626-524-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.700360531223X0400X
FLDN310191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics