Provider Demographics
NPI:1053449439
Name:ASGARI, ALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ASGARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 S RANCHO SANTA FE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2347
Mailing Address - Country:US
Mailing Address - Phone:917-747-6193
Mailing Address - Fax:760-744-3001
Practice Address - Street 1:327 S RANCHO SANTA FE RD
Practice Address - Street 2:SUITE G
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2347
Practice Address - Country:US
Practice Address - Phone:917-747-6193
Practice Address - Fax:760-744-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY50 0523671223P0221X
CA584681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053449439OtherMEDI-CAL
NY02804222Medicaid