Provider Demographics
NPI:1891678652
Name:ALI, KHALED ISHAQ (DMD)
Entity type:Individual
Prefix:DR
First Name:KHALED
Middle Name:ISHAQ
Last Name:ALI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 W DUVAL MINE RD STE 179
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5293
Mailing Address - Country:US
Mailing Address - Phone:520-867-6406
Mailing Address - Fax:520-214-0069
Practice Address - Street 1:1325 W DUVAL MINE RD STE 179
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5293
Practice Address - Country:US
Practice Address - Phone:520-867-6406
Practice Address - Fax:520-214-0069
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0125921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice