Provider Demographics
NPI:1821187592
Name:RIAZI, ALI MOTAMED (DDS)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:MOTAMED
Last Name:RIAZI
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 1:27038 PACIFIC TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5001
Mailing Address - Country:US
Mailing Address - Phone:714-349-9208
Mailing Address - Fax:
Practice Address - Street 1:9474 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5504
Practice Address - Country:US
Practice Address - Phone:562-803-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist