NPIMap

Individual provider Active NPI

Mariam Khan, DDS

  • Pediatric Dentistry
  • Stamford, CT
National Provider Identifier
1760869457
Registry record updated Jul 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
12629 Issued in CT
Practice address
127 Greyrock PL
Stamford, CT 06901-3100
Phone
(203) 323-5439
NPI assigned
May 1, 2015
Last updated
Jul 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 019.031527 IL
Pediatric Dentistry 1223P0221X 060919-01 NY
Pediatric Dentistry 1223P0221X 12629 CT Primary

Addresses

Primary practice location

127 Greyrock PL
Stamford, CT 06901-3100

Mailing address

3905 Grenville Rd
University Heights, OH 44118-3735

Other practice location 1

379 5th Ave
Brooklyn, NY 11215-3303
Phone (917) 397-1341

Other practice location 2

568 Union Ave
Brooklyn, NY 11211-1762
Phone (718) 899-4500

Other practice location 3

26 Belden Ave Ste B
Norwalk, CT 06850-3353
Phone (203) 323-5439

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
12629CTMDPediatric Dentist
019.031527ILMDPediatric Dentist
060919-01NYMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Presto Dental PLLC Pediatric Dentistry CurrentSince Nov 3, 2024 Accepting new patients
All About Kids Pediatric Dentistry Pediatric Dentistry PastSince Jul 5, 2020 Accepting new patients
Bitesize Pediatric Dentistry of Bushwick Pediatric Dentistry PastSince Mar 26, 2023 Accepting new patients
Bitesize Pediatric Dentistry of Williamsburg PLLC Single Specialty Past Accepting new patients

Organizations & group practices 4

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": "1430438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596067200000",
    "number": "1760869457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 GRENVILLE RD",
            "city": "UNIVERSITY HEIGHTS",
            "state": "OH",
            "postal_code": "441183735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 GREYROCK PL",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069013100",
            "telephone_number": "203-323-5439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "379 5th Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112153303",
            "country_code": "US",
            "telephone_number": "917-397-1341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "568 Union Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112111762",
            "country_code": "US",
            "telephone_number": "718-899-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "26 Belden Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "068503353",
            "country_code": "US",
            "telephone_number": "203-323-5439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "MARIAM",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-01",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.031527",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "060919-01",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CT",
            "license": "12629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.