Provider Demographics
NPI:1407951403
Name:ALI, MUHAMMAD R (BDS)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:R
Last Name:ALI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 N WICKHAM RD STE 116
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8127
Mailing Address - Country:US
Mailing Address - Phone:321-956-0999
Mailing Address - Fax:321-752-4274
Practice Address - Street 1:2447 N WICKHAM RD STE 116
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8127
Practice Address - Country:US
Practice Address - Phone:321-956-0999
Practice Address - Fax:321-752-4274
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice