Provider Demographics
NPI:1891255964
Name:ALI ISMAIL DDS PLLC
Entity Type:Organization
Organization Name:ALI ISMAIL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-520-0456
Mailing Address - Street 1:41920 WOLFE PASS
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2867
Mailing Address - Country:US
Mailing Address - Phone:248-520-0456
Mailing Address - Fax:
Practice Address - Street 1:8701 N SHELDON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1970
Practice Address - Country:US
Practice Address - Phone:734-451-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1023421963OtherDENTIST
MI1154747095OtherDENTIST