1033373113 NPI number — KHALDOUN F AL-AJLOUNI DDS PA

Table of content: KHALDOUN F AL-AJLOUNI DDS PA (NPI 1033373113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033373113 NPI number — KHALDOUN F AL-AJLOUNI DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-AJLOUNI
Provider First Name:
KHALDOUN
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033373113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W SOUTHLAKE BLVD
Provider Second Line Business Mailing Address:
STE 146
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-6100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-251-9333
Provider Business Mailing Address Fax Number:
817-251-9320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W SOUTHLAKE BLVD
Provider Second Line Business Practice Location Address:
STE 146
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-251-9333
Provider Business Practice Location Address Fax Number:
817-251-9320
Provider Enumeration Date:
07/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  22403 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0700X , with the licence number: 22403 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0700X , with the licence number: 22403 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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