Healthcare Provider Details

I. General information

NPI: 1548920242
Provider Name (Legal Business Name): ALI GHOWSI DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27620 MARGUERITE PKWY STE D
MISSION VIEJO CA
92692-3607
US

IV. Provider business mailing address

1009 BLENHEIM AVE
CHARLOTTESVILLE VA
22902-6212
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-6633
  • Fax:
Mailing address:
  • Phone: 408-220-4622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401417664
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: