Provider Demographics
NPI:1174739775
Name:KHAN, RUBABA M (DDS)
Entity type:Individual
Prefix:
First Name:RUBABA
Middle Name:M
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 1:30 RIVER CT
Mailing Address - Street 2:APT 1214
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2101
Mailing Address - Country:US
Mailing Address - Phone:917-626-8883
Mailing Address - Fax:
Practice Address - Street 1:2 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3550
Practice Address - Country:US
Practice Address - Phone:973-399-5000
Practice Address - Fax:973-399-5000
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102341100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist