Provider Demographics
NPI:1598240400
Name:ALY, DEENA (DDS)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:ALY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 UPLAND ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-5619
Mailing Address - Country:US
Mailing Address - Phone:832-876-2084
Mailing Address - Fax:
Practice Address - Street 1:1423 UPLAND ORCHARD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5619
Practice Address - Country:US
Practice Address - Phone:832-876-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty