Provider Demographics
NPI:1881728970
Name:ALI, MAHDI (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:MAHDI
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2924
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-2924
Mailing Address - Country:US
Mailing Address - Phone:480-208-7436
Mailing Address - Fax:866-316-7796
Practice Address - Street 1:3830 W PINNACLE PEAK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-4006
Practice Address - Country:US
Practice Address - Phone:623-587-0300
Practice Address - Fax:866-316-7796
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026327122300000X
AZD7481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9180012Medicaid