Ethan S Khazali, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN124057 Issued in GA

Practice address

918 Market Place Blvd
Cumming, GA 30041-7920

Phone

(470) 695-3071

NPI assigned

Aug 23, 2018

Last updated

Jan 23, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Washington Dental Corporation, PC

  dba Maple Valley Modern Dentistry

  • General Practice Dentistry
  • Maple Valley, WA
  • NPI 1609259019
  NPD (past)

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769126400000",
    "number": "1710468228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 MARKET PLACE BLVD",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417920",
            "telephone_number": "470-470-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 MARKET PLACE BLVD",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417920",
            "telephone_number": "470-695-3071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "932 Allen Rd",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372143507",
            "country_code": "US",
            "telephone_number": "615-781-9335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAZALI",
        "first_name": "ETHAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-23",
        "last_updated": "2026-01-23",
        "certification_date": "2026-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS111702",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN124057",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11443",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60862683",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clayton Keye, PMHNP
• Roshan N Khaki, R.D.,L.D.,CDE
• Jeremy S Khan, M.D.
• Omar T Khan, DO
• Adam M Khanu, PA-C
• Elaheh Kheirbakhsh, PAC
• Vikram Khetpal, MD
• Holly Khorramzadeh, APRN
• Rinku Khullar
• Evelyn Kidd, OTR/L

• Dentist in Cumming, GA
• Providers in Cumming, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.