Provider Demographics
NPI:1477667020
Name:ALI ALEM DENTAL CLINIC
Entity Type:Organization
Organization Name:ALI ALEM DENTAL CLINIC
Other - Org Name:AADC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT OF AADC
Authorized Official - Prefix:DR
Authorized Official - First Name:KIANOUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-822-3785
Mailing Address - Street 1:2440 M STREET NW
Mailing Address - Street 2:#608
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-822-3785
Mailing Address - Fax:202-822-9096
Practice Address - Street 1:2440 M STREET NW
Practice Address - Street 2:#608
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-822-3785
Practice Address - Fax:202-822-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC4802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty