Provider Demographics
NPI:1245573856
Name:ALI, MOMODU A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOMODU
Middle Name:A
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 1:10909 OBSERVATORY WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3583
Mailing Address - Country:US
Mailing Address - Phone:813-453-0414
Mailing Address - Fax:
Practice Address - Street 1:37039 SR 54
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6933
Practice Address - Country:US
Practice Address - Phone:813-783-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDN 200741223G0001X
FLDN20074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice