Provider Demographics
NPI:1447235940
Name:ELYASSI, ALI REZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:REZA
Last Name:ELYASSI
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:7525 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3509
Mailing Address - Country:US
Mailing Address - Phone:301-982-4555
Mailing Address - Fax:301-982-4557
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-982-4555
Practice Address - Fax:301-982-4557
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD137311223G0001X
HIDT-22831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery