Individual provider Active NPI

Maha Khan, DDS

  • General Practice Dentistry
  • Greenville, SC
National Provider Identifier
1417567850
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10139 Issued in SC
Practice address
1803 Woodruff Rd
Greenville, SC 29607-5936
Phone
(864) 297-5268
NPI assigned
Jul 31, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401417055 VA
General Practice Dentistry 1223G0001X 10139 SC Primary

Addresses

Primary practice location

1803 Woodruff Rd
Greenville, SC 29607-5936

Mailing address

238 Brandau LN
Simpsonville, SC 29680-7266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
10139SCMDMental Health Counselor
0401417055VAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Family Dental Health Group LLC General Practice CurrentSince Sep 1, 2024 Accepting new patients
Real Life Dental of Christiansburg, PLLC General Practice PastSince Aug 1, 2020 Accepting new patients
Flat Rock Family Dentistry, P.a. General Practice PastSince Sep 20, 2022 Accepting new patients

Locations

1803 Woodruff Rd
Greenville, SC 29607
Phone (864) 297-5268

Organizations & group practices 3

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": "1596153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1417567850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 BRANDAU LN",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296807266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 WOODRUFF RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296075936",
            "telephone_number": "864-297-5268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MAHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-31",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417055",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.