Healthcare Provider Details

I. General information

NPI: 1821439175
Provider Name (Legal Business Name): ALI POURIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 DENTAL SCIENCE S UNIVERSITY OF IOWA
IOWA CITY IA
52242-1001
US

IV. Provider business mailing address

356 DENTAL SCIENCE S
IOWA CITY IA
52242-1001
US

V. Phone/Fax

Practice location:
  • Phone: 319-335-7346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number5939
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: