Provider Demographics
NPI:1962406397
Name:ALI-KHAN, HUSAIN (MD DMD)
Entity type:Individual
Prefix:DR
First Name:HUSAIN
Middle Name:
Last Name:ALI-KHAN
Suffix:
Gender:M
Credentials:MD DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:BLDG H
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5518
Mailing Address - Country:US
Mailing Address - Phone:404-805-2821
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:BLDG H
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5518
Practice Address - Country:US
Practice Address - Phone:404-805-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0514231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA19NCCBPMedicare ID - Type Unspecified
GAU93873Medicare UPIN