Mabroor A Khan, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

13683 Issued in CT

Practice address

115 Bridge St
Groton, CT 06340-3603

Phone

(860) 446-8744

NPI assigned

Mar 25, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: mabroor.khan@upmcdirect.com

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

• Bridgeworks LLC

  • General Practice Dentistry
  • Groton, CT
  • NPI 1720034457
  NPD (past)

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1538629498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 BRIDGE ST",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063403603",
            "telephone_number": "860-446-8744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BRIDGE ST",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063403603",
            "telephone_number": "860-446-8744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MABROOR",
        "middle_name": "A",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-25",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS042583",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "13683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1037653870001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William P Keefe, M.D.
• Thomas Anthony Keemon, RPH
• Katy E Kelliher, PTA
• Leslie Kelly, RN
• Lajward Khan
• Daniel Adam Kilhefner, SUBIDC
• Alexander John Kim, MD
• Sean Hyungbeom Kim
• Jeremiah Loius King, IDC
• Marissa King

• Dentist in Groton, CT
• Providers in Groton, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.