Provider Demographics
NPI:1619969375
Name:KHALLOUF, ALFRED G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:G
Last Name:KHALLOUF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 DIXON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-4979
Mailing Address - Country:US
Mailing Address - Phone:484-221-9397
Mailing Address - Fax:
Practice Address - Street 1:536 E TIOGA ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-8213
Practice Address - Country:US
Practice Address - Phone:301-412-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist