Provider Demographics
NPI:1942423173
Name:SHEIKHOLISLAM, ALI REZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:REZA
Last Name:SHEIKHOLISLAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SCRIPPS DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6207
Mailing Address - Country:US
Mailing Address - Phone:916-929-3737
Mailing Address - Fax:916-929-3739
Practice Address - Street 1:2 SCRIPPS DR
Practice Address - Street 2:SUITE 301
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6207
Practice Address - Country:US
Practice Address - Phone:916-929-3737
Practice Address - Fax:916-929-3739
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice