Provider Demographics
NPI:1548369291
Name:KHAN, FARAH N (DDS)
Entity type:Individual
Prefix:DR
First Name:FARAH
Middle Name:N
Last Name:KHAN
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 1:45535 HANFORD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187
Mailing Address - Country:US
Mailing Address - Phone:734-254-0786
Mailing Address - Fax:734-254-0861
Practice Address - Street 1:45535 HANFORD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-254-0786
Practice Address - Fax:734-254-0861
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5437281223G0001X
MI5474311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1698319OtherUNITED CONCORDIA
MI4755112Medicaid