Individual
MABROOR A KHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
115 BRIDGE ST, GROTON, CT 06340-3603
(860) 446-8744
Mailing address
115 BRIDGE ST, GROTON, CT 06340-3603
(860) 446-8744
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13683
CT
122300000X
Dentist
DS042583
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1037653870001
—
PA
Enumeration date
03/25/2019
Last updated
09/05/2023
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