Individual
MUJTABA KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1931 MAIN ST, GREEN BAY, WI 54302-3920
(920) 499-2770
Mailing address
2345 SUNNY LANE, APT P, GREEN BAY, WI 54313
(316) 573-9707
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1001454-15
WI
122300000X
Dentist
12012588A
IN
Other
Enumeration date
08/16/2016
Last updated
01/26/2017
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