Provider Demographics
NPI:1033373113
Name:AL-AJLOUNI, KHALDOUN F (DDS PA)
Entity Type:Individual
Prefix:
First Name:KHALDOUN
Middle Name:F
Last Name:AL-AJLOUNI
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W SOUTHLAKE BLVD
Mailing Address - Street 2:STE 146
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6100
Mailing Address - Country:US
Mailing Address - Phone:817-251-9333
Mailing Address - Fax:817-251-9320
Practice Address - Street 1:100 W SOUTHLAKE BLVD
Practice Address - Street 2:STE 146
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6100
Practice Address - Country:US
Practice Address - Phone:817-251-9333
Practice Address - Fax:817-251-9320
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22403122300000X, 1223P0700X
IL224031223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist