Provider Demographics
NPI:1811060692
Name:ATTAIE, ALI (DDS)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:ATTAIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39-05 61ST STREET
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3566
Mailing Address - Country:US
Mailing Address - Phone:718-899-5437
Mailing Address - Fax:718-899-5203
Practice Address - Street 1:39-05 61ST STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3566
Practice Address - Country:US
Practice Address - Phone:718-899-5437
Practice Address - Fax:718-899-5203
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0522511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02694984Medicaid
NY02694984Medicaid