Raed Al Ajlouni, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

21791 Issued in TX

Practice address

100 W. Southlake Blvd.
Ste 146
Southlake, TX 76092

Phone

(817) 251-9333

Fax

(817) 251-9320

NPI assigned

May 29, 2009

Last updated

Jun 8, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 19, 2016 through Apr 19, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Davinci Dentistry

  • Dentist
  • Southlake, TX
  • NPI 1033242946
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244419200000",
    "number": "1356577795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W. SOUTHLAKE BLVD.",
            "address_2": "STE 146",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-251-9333",
            "fax_number": "817-251-9320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W. SOUTHLAKE BLVD.",
            "address_2": "STE 146",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-251-9333",
            "fax_number": "817-251-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL AJLOUNI",
        "first_name": "RAED",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-29",
        "last_updated": "2009-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "21791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tahmid Ahmad, RBT
• Ai Psychiatry PA
• Mallory Aiman, RBT
• Amy Airington
• Crystal Chinonye Akunne, PMHNP
• Khaldoun F Al-Ajlouni, DDS PA
• Thomas Albaugh, PT, DPT
• Albertsons LLC (Savon Pharmacy)
• Pablo R Albores, CRNA
• Tasha Lynn Albus, FNP-BC

• Dentist in Southlake, TX
• Providers in Southlake, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.