Provider Demographics
NPI:1487328563
Name:AL KHAFAJI, AHMAD (DMD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:AL KHAFAJI
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 1:16 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1707
Mailing Address - Country:US
Mailing Address - Phone:470-892-8847
Mailing Address - Fax:
Practice Address - Street 1:20 EAST ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1638
Practice Address - Country:US
Practice Address - Phone:781-826-4499
Practice Address - Fax:603-546-0755
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046751223G0001X
MADN1859237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice