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General NPI Number Information
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NPI Number | 1457080855
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Entity Type | Individual
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Provider Name | KHALED AL NASR ALLAH DDS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 2380 MERCHANT MILE
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City | COLUMBUS
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State | IN
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Zip | 47201-1557
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Country | US
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Telephone | 812-669-0250
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 N MERIDIAN ST APT 603
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2357
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Country | US
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Telephone | 317-832-9459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12013774A
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License Number State | IN
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