Provider Demographics
NPI:1588001218
Name:AMROLLAHIE, ALI (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:AMROLLAHIE
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DURIAN ST STE C
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6240
Mailing Address - Country:US
Mailing Address - Phone:949-510-7795
Mailing Address - Fax:
Practice Address - Street 1:105 DURIAN ST STE C
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6240
Practice Address - Country:US
Practice Address - Phone:949-510-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANAOtherNA