Provider Demographics
NPI:1295904605
Name:ALI, HAYAT (DDS)
Entity type:Individual
Prefix:DR
First Name:HAYAT
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3284 W 117TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-1703
Mailing Address - Country:US
Mailing Address - Phone:216-476-9930
Mailing Address - Fax:216-476-9932
Practice Address - Street 1:3284 W 117TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-1703
Practice Address - Country:US
Practice Address - Phone:216-476-9930
Practice Address - Fax:216-476-9932
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2003790Medicaid