Provider Demographics
NPI:1790955532
Name:HAYAT ALI DDS INC
Entity Type:Organization
Organization Name:HAYAT ALI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-352-6006
Mailing Address - Street 1:9853 JOHNNYCAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6700
Mailing Address - Country:US
Mailing Address - Phone:440-352-6006
Mailing Address - Fax:440-352-6006
Practice Address - Street 1:9853 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6700
Practice Address - Country:US
Practice Address - Phone:440-352-6006
Practice Address - Fax:440-352-6006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAYAT ALI DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300205661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4410OtherDORAL
OH2003790Medicaid
4410OtherDORAL