Provider Demographics
NPI:1487624086
Name:KHAN, FATIMA (DDS)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
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 1:400 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-2045
Mailing Address - Country:US
Mailing Address - Phone:810-787-5001
Mailing Address - Fax:810-424-6029
Practice Address - Street 1:G3373 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1244
Practice Address - Country:US
Practice Address - Phone:810-743-6830
Practice Address - Fax:810-743-7102
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4262334Medicaid