Provider Demographics
NPI:1730882457
Name:KHAN, RIDILA (DDS)
Entity type:Individual
Prefix:
First Name:RIDILA
Middle Name:
Last Name:KHAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:RIDILA
Other - Middle Name:
Other - Last Name:RABBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 W BARCELONA LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2601
Mailing Address - Country:US
Mailing Address - Phone:559-708-2587
Mailing Address - Fax:
Practice Address - Street 1:7525 N CEDAR AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2698
Practice Address - Country:US
Practice Address - Phone:559-439-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601601122300000X
CA1111441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist