Provider Demographics
NPI:1629194378
Name:ALI, FARIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FARIDA
Middle Name:
Last Name:ALI
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 1:55 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1251
Mailing Address - Country:US
Mailing Address - Phone:732-367-4110
Mailing Address - Fax:732-367-9533
Practice Address - Street 1:55 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1251
Practice Address - Country:US
Practice Address - Phone:732-367-4110
Practice Address - Fax:732-367-9533
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI22548001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice