Provider Demographics
NPI:1861842502
Name:ROUHI NOZADI, ALI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ROUHI NOZADI
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 1:28 CORMORANT PLACE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:310-498-5642
Mailing Address - Fax:207-282-7351
Practice Address - Street 1:57 BARRA RD STE 3
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9446
Practice Address - Country:US
Practice Address - Phone:207-282-1305
Practice Address - Fax:207-282-7351
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX402561223X0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics