Provider Demographics
NPI:1467939074
Name:KHAN, MOIZ S (DMD)
Entity type:Individual
Prefix:
First Name:MOIZ
Middle Name:S
Last Name:KHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13A BEAVER CT
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7895
Mailing Address - Country:US
Mailing Address - Phone:240-506-3550
Mailing Address - Fax:
Practice Address - Street 1:2298 WILKES BARRE TOWNSHIP MARKET PL
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6061
Practice Address - Country:US
Practice Address - Phone:561-934-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0435081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice