Provider Demographics
NPI:1417932773
Name:JALALI, HOSSEIN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOSSEIN
Middle Name:A
Last Name:JALALI
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 1:991 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2665
Mailing Address - Country:US
Mailing Address - Phone:651-633-1311
Mailing Address - Fax:651-633-4339
Practice Address - Street 1:991 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-2665
Practice Address - Country:US
Practice Address - Phone:651-633-1311
Practice Address - Fax:651-633-4339
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0009762OtherMEDICAL ASSISTANCE