Provider Demographics
NPI:1114157229
Name:ALI, TALIB S (DMD)
Entity Type:Individual
Prefix:
First Name:TALIB
Middle Name:S
Last Name:ALI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W LEE HWY
Mailing Address - Street 2:STE 197
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2093
Mailing Address - Country:US
Mailing Address - Phone:540-347-9364
Mailing Address - Fax:540-341-0183
Practice Address - Street 1:251 W LEE HWY
Practice Address - Street 2:STE 197
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2093
Practice Address - Country:US
Practice Address - Phone:540-347-9364
Practice Address - Fax:540-341-0183
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice