Healthcare Provider Details

I. General information

NPI: 1417863762
Provider Name (Legal Business Name): KHALID ALI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 E FRANKLIN AVE
MINNEAPOLIS MN
55404-2923
US

IV. Provider business mailing address

2740 FAIRVIEW AVE N UNIT 221
ROSEVILLE MN
55113-1354
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-8086
  • Fax:
Mailing address:
  • Phone: 651-214-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD15556
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: