Provider Demographics
NPI:1114659208
Name:KHALIL, ALI MOHAMED-ALI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:MOHAMED-ALI
Last Name:KHALIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8640
Mailing Address - Country:US
Mailing Address - Phone:813-778-2044
Mailing Address - Fax:
Practice Address - Street 1:2638 GUNN HWY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2541
Practice Address - Country:US
Practice Address - Phone:813-328-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist