Provider Demographics
NPI:1326466152
Name:KHAN ALI DENTAL CORPORATION
Entity Type:Organization
Organization Name:KHAN ALI DENTAL CORPORATION
Other - Org Name:KOOL KIDZ DENTIST & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-378-9389
Mailing Address - Street 1:18 RANCHO CAMINO DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-7003
Mailing Address - Country:US
Mailing Address - Phone:949-378-9389
Mailing Address - Fax:
Practice Address - Street 1:18 RANCHO CAMINO DR
Practice Address - Street 2:SUITE 104
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7003
Practice Address - Country:US
Practice Address - Phone:949-378-9389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty