Healthcare Provider Details

I. General information

NPI: 1356194393
Provider Name (Legal Business Name): ALI SULTAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 GEORGIA AVE NW
WASHINGTON DC
20012-2910
US

IV. Provider business mailing address

3425 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2941
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-0303
  • Fax:
Mailing address:
  • Phone: 503-258-7430
  • 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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN2000409
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: