Provider Demographics
NPI:1912750761
Name:ABIDALI, AMMAR (DMD)
Entity Type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:ABIDALI
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 1:7700 W ASPERA BLVD APT 1066
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7921
Mailing Address - Country:US
Mailing Address - Phone:480-758-1444
Mailing Address - Fax:
Practice Address - Street 1:6001 REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLAND
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical