Provider Demographics
NPI:1659434975
Name:MAALI, NASSER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NASSER
Middle Name:
Last Name:MAALI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 UNO CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6653
Mailing Address - Country:US
Mailing Address - Phone:815-725-0066
Mailing Address - Fax:815-725-1133
Practice Address - Street 1:2 UNO CIR
Practice Address - Street 2:SUITE C
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6653
Practice Address - Country:US
Practice Address - Phone:815-725-0066
Practice Address - Fax:815-725-1133
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223E0200XDental ProvidersDentistEndodontics