1477667020 NPI number — ALI ALEM DENTAL CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477667020 NPI number — ALI ALEM DENTAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALI ALEM DENTAL CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AADC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477667020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 M STREET NW
Provider Second Line Business Mailing Address:
#608
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-822-3785
Provider Business Mailing Address Fax Number:
202-822-9096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 M STREET NW
Provider Second Line Business Practice Location Address:
#608
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-822-3785
Provider Business Practice Location Address Fax Number:
202-822-9096
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALEM
Authorized Official First Name:
KIANOUSH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF AADC
Authorized Official Telephone Number:
202-822-3785

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4802 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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