Provider Demographics
NPI:1235829813
Name:ABDALLAH, AHMAD KHAMIS (BA, DMD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:KHAMIS
Last Name:ABDALLAH
Suffix:
Gender:
Credentials:BA, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11761 ARNOLD PALMER CT
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4525
Mailing Address - Country:US
Mailing Address - Phone:651-354-2514
Mailing Address - Fax:
Practice Address - Street 1:1625 RADIO DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9407
Practice Address - Country:US
Practice Address - Phone:651-340-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND150871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice