Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22403 | TX |
N | 1223P0700X | Prosthodontist | 22403 | IL |
Y | 1223P0700X | Prosthodontist | 22403 | TX |
NPI | 1033373113 |
---|---|
Provider Name | Khaldoun F Al-Ajlouni |
First Address | Southlake, TX 76092-6100 |
Second Address | Southlake, TX 76092-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 22/05/2019 |