Organization
LIBERTY 786 DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RBEEA M KHAN (D.D.S)
(718) 322-4200
Entity
Organization
Contact information
Practice address
11302 LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-1808
(718) 322-4200
(718) 322-1144
Mailing address
11302 LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-1808
(718) 322-4200
(718) 322-1144
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
054968-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03060184
—
NY
Enumeration date
10/14/2011
Last updated
10/14/2011
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