MEDICARE: SAMI A ALI DDS INC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1861214033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMI A ALI DDS INC

Provider Business Mailing Address
First Line	:	18590 VAN BUREN BLVD STE 2B
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-4804
Country	:	US
Telephone Number	:	951-398-7900
Fax Number	:	951-398-7903

Provider Business Practice Location Address
First Line	:	18590 VAN BUREN BLVD STE 2B
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-4804
Country	:	US
Telephone Number	:	951-398-7900
Fax Number	:	951-398-7903

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	SAMI A ALI
Credential	:	DDS., MSED.
Telephone Number	:	951-398-7900

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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