Provider Demographics
NPI:1154486819
Name:ALI, ISHAQ GHALEB (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISHAQ
Middle Name:GHALEB
Last Name:ALI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31513 E SIANNA DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-8840
Mailing Address - Country:US
Mailing Address - Phone:520-400-0023
Mailing Address - Fax:
Practice Address - Street 1:9811 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3877
Practice Address - Country:US
Practice Address - Phone:313-870-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-23
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist