MEDICARE: DR. AMIRALI AGHILI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	35272	TX

General Provider Information

NPI Number	:	1245891134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIRALI AGHILI

Provider Business Mailing Address
First Line	:	5905 W CHARLESTON BLVD APT 343
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1378
Country	:	US
Telephone Number	:	714-907-3205
Fax Number	:

Provider Business Practice Location Address
First Line	:	7878 GATEWAY BLVD E
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79915-1838
Country	:	US
Telephone Number	:	714-907-3205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2019
Last Update Date	:	06/22/2019

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