Individual provider Active NPI

Monisha Khanna, DDS

  • Dentist
  • Rockingham, VA
National Provider Identifier
1063826683
Registry record updated Jun 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401415751 Issued in VA
Practice address
1451 Brookhaven Dr
Rockingham, VA 22801-3584
Phone
(540) 432-6616
NPI assigned
Jun 12, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401415751 VA Primary

Addresses

Primary practice location

1451 Brookhaven Dr
Rockingham, VA 22801-3584

Mailing address

1451 Brookhaven Dr
Rockingham, VA 22801-3584
Phone (908) 307-2549

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, CO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140930001505 VA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7517187354
I20170109001301 CO Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 7517187354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0401415751VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Hidden Lake Dental Group, LLP Past Accepting new patients
Denicola Khanna DDS, PLLC PastSince Jun 14, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592179200000",
    "number": "1063826683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 BROOKHAVEN DR",
            "city": "ROCKINGHAM",
            "state": "VA",
            "postal_code": "228013584",
            "telephone_number": "908-307-2549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 BROOKHAVEN DR",
            "city": "ROCKINGHAM",
            "state": "VA",
            "postal_code": "228013584",
            "telephone_number": "540-432-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANNA",
        "first_name": "MONISHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-12",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401415751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockingham, VA

Sources for this page

Verify at the official NPI Registry.