Provider Demographics
NPI:1811540081
Name:FAHHAM, ALI (DDS)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:
Last Name:FAHHAM
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 1:2319 RAYFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4216
Mailing Address - Country:US
Mailing Address - Phone:832-585-0839
Mailing Address - Fax:
Practice Address - Street 1:2319 RAYFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4216
Practice Address - Country:US
Practice Address - Phone:832-585-0839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032313122300000X
TX35735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist