Provider Demographics
NPI:1902005408
Name:AHMAD, HILAL KHAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:HILAL
Middle Name:KHAN
Last Name:AHMAD
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 1:10024 SE 240 ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031
Mailing Address - Country:US
Mailing Address - Phone:253-859-6000
Mailing Address - Fax:
Practice Address - Street 1:11012 CANYON RD EAST
Practice Address - Street 2:SUITE 40
Practice Address - City:PUYLLUP
Practice Address - State:WA
Practice Address - Zip Code:98373
Practice Address - Country:US
Practice Address - Phone:253-531-1900
Practice Address - Fax:253-859-0799
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5002456Medicare UPIN