Individual
SHAUNA KHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
982 E MAIN ST, BRIDGEPORT, CT 06608-1913
(203) 696-3270
(203) 332-0376
Mailing address
982 E MAIN ST, BRIDGEPORT, CT 06608-1913
(203) 696-3270
(203) 332-0376
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
007438
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007438
STATE LICENSE
CT
Enumeration date
10/06/2009
Last updated
10/06/2009
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