Provider Demographics
NPI:1376627844
Name:GHATRI, ALI YOUSEF (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:YOUSEF
Last Name:GHATRI
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 1:6564 LOISDALE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1822
Mailing Address - Country:US
Mailing Address - Phone:703-719-5828
Mailing Address - Fax:
Practice Address - Street 1:6564 LOISDALE CT STE 110
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1822
Practice Address - Country:US
Practice Address - Phone:703-719-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-0079501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics