Provider Demographics
NPI:1629473996
Name:AL SAUD, DALI
Entity Type:Individual
Prefix:
First Name:DALI
Middle Name:
Last Name:AL SAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11552 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2644
Mailing Address - Country:US
Mailing Address - Phone:586-573-7500
Mailing Address - Fax:586-573-7502
Practice Address - Street 1:11552 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2644
Practice Address - Country:US
Practice Address - Phone:586-573-7500
Practice Address - Fax:586-573-7502
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist