Provider Demographics
NPI:1730596891
Name:KHAN, ZIA ULLAH (DDS)
Entity type:Individual
Prefix:
First Name:ZIA
Middle Name:ULLAH
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N. CLARK STREET, 6TH FLOOR, DENTAL DREAMS LLC
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:312-274-4530
Mailing Address - Fax:
Practice Address - Street 1:100 MATTIE HARRIS RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IN
Practice Address - Zip Code:47330-1335
Practice Address - Country:US
Practice Address - Phone:765-855-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN019029965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist