Provider Demographics
NPI:1538728878
Name:KHAN, AKBAR (DMD)
Entity type:Individual
Prefix:
First Name:AKBAR
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CAMBRIDGE ST STE 401
Mailing Address - Street 2:MGH DENTAL GROUP
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2750
Mailing Address - Country:US
Mailing Address - Phone:617-726-1075
Mailing Address - Fax:
Practice Address - Street 1:1049 EDGEWATER ST NW STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4046
Practice Address - Country:US
Practice Address - Phone:503-874-4560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL14006204E00000X
ORD116351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery