Provider Demographics
NPI:1487887246
Name:KHAN, RBEEA MUZAFFAR (DDS)
Entity type:Individual
Prefix:DR
First Name:RBEEA
Middle Name:MUZAFFAR
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 1:16012 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4120
Mailing Address - Country:US
Mailing Address - Phone:718-874-2047
Mailing Address - Fax:
Practice Address - Street 1:18402 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4858
Practice Address - Country:US
Practice Address - Phone:718-297-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054968-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice