Provider Demographics
NPI:1184473845
Name:ALIDINA, IMRAN ALI
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:ALI
Last Name:ALIDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 GIOTTO CRES
Mailing Address - Street 2:
Mailing Address - City:MAPLE
Mailing Address - State:ON
Mailing Address - Zip Code:L6A3N7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:904 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6511
Practice Address - Country:US
Practice Address - Phone:512-876-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice