Provider Demographics
NPI:1295872307
Name:KHAN, NEELOFAR ALI (DDS)
Entity type:Individual
Prefix:
First Name:NEELOFAR
Middle Name:ALI
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 1:4410 DUCKHORN DR
Mailing Address - Street 2:ST A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2589
Mailing Address - Country:US
Mailing Address - Phone:916-575-7536
Mailing Address - Fax:916-575-9413
Practice Address - Street 1:3160 SPARROW DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834
Practice Address - Country:US
Practice Address - Phone:916-575-7536
Practice Address - Fax:916-575-9413
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice