Provider Demographics
NPI:1821839853
Name:ALI, MOHAMED ELHADI MOHAMED (DMD)
Entity type:Individual
Prefix:
First Name:MOHAMED ELHADI
Middle Name:MOHAMED
Last Name:ALI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WASHINGTON ST APT 506
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5870
Mailing Address - Country:US
Mailing Address - Phone:929-248-9840
Mailing Address - Fax:
Practice Address - Street 1:9990 W 26TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1581
Practice Address - Country:US
Practice Address - Phone:303-232-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00206018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty