Healthcare Provider Details

I. General information

NPI: 1306373626
Provider Name (Legal Business Name): ALI MOTANABBEH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9331 MISSION GORGE RD STE 105
SANTEE CA
92071-3883
US

IV. Provider business mailing address

1124 FESTIVAL RD
SAN MARCOS CA
92078-2806
US

V. Phone/Fax

Practice location:
  • Phone: 619-448-2158
  • Fax: 619-448-2165
Mailing address:
  • Phone: 760-809-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number102204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: