Provider Demographics
NPI:1588824726
Name:MARY ALI, D.D.S,INC
Entity Type:Organization
Organization Name:MARY ALI, D.D.S,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-369-2696
Mailing Address - Street 1:525 S FAIRMONT AVE STE H
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3860
Mailing Address - Country:US
Mailing Address - Phone:209-369-2696
Mailing Address - Fax:
Practice Address - Street 1:525 S FAIRMONT AVE STE H
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3860
Practice Address - Country:US
Practice Address - Phone:209-369-2696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty