Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5315229232 | MI |
NPI | 1033670922 |
---|---|
Provider Name | Dr. Ahmed Salah Ali |
First Address | Chesterfield, MI 48051-2014 |
Second Address | Chesterfield, MI 48051-2014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2019 |
Last Update Date | 19/11/2021 |