Provider Demographics
NPI:1841819141
Name:AL-SAMMAK, ALI (DMD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:
Last Name:AL-SAMMAK
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SPRINGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1736
Mailing Address - Country:US
Mailing Address - Phone:248-480-3956
Mailing Address - Fax:
Practice Address - Street 1:30070 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5718
Practice Address - Country:US
Practice Address - Phone:586-598-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0327711223S0112X, 122300000X
MI243540812441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA425048961939OtherDRIVER LICENSE