Provider Demographics
NPI:1295090462
Name:KHERANI, ANJUM (DMD)
Entity type:Individual
Prefix:
First Name:ANJUM
Middle Name:
Last Name:KHERANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 GESSNER RD STE 240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2516
Mailing Address - Country:US
Mailing Address - Phone:832-203-8577
Mailing Address - Fax:
Practice Address - Street 1:947 GESSNER ROAD
Practice Address - Street 2:UNIT A 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:832-203-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX325811223P0221X
390200000X
NY057377-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32581OtherTEXAS LICENSE