Provider Demographics
NPI:1811612864
Name:ALY, AHMED SHERIF (DDS)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:SHERIF
Last Name:ALY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 CANVASBACK LANE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:216-375-9103
Mailing Address - Fax:
Practice Address - Street 1:5969 E BROAD STREET, SUITE 303
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-626-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2025-01-08
Deactivation Date:2023-05-15
Deactivation Code:
Reactivation Date:2023-06-28
Provider Licenses
StateLicense IDTaxonomies
OH30.0277441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice