Provider Demographics
NPI:1245891134
Name:AGHILI, AMIRALI
Entity type:Individual
Prefix:DR
First Name:AMIRALI
Middle Name:
Last Name:AGHILI
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 1:5905 W CHARLESTON BLVD APT 343
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1378
Mailing Address - Country:US
Mailing Address - Phone:714-907-3205
Mailing Address - Fax:
Practice Address - Street 1:7878 GATEWAY BLVD E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1838
Practice Address - Country:US
Practice Address - Phone:714-907-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist