Provider Demographics
NPI:1689724684
Name:KHAN, ALI MOHAMMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:MOHAMMED
Last Name:KHAN
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 1:3763 MONARCH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564
Mailing Address - Country:US
Mailing Address - Phone:213-820-6487
Mailing Address - Fax:213-749-1889
Practice Address - Street 1:3450 MONTGOMERY ROAD, UNIT 8
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:213-253-5160
Practice Address - Fax:213-253-5158
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190280181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice