Healthcare Provider Details

I. General information

NPI: 1831998376
Provider Name (Legal Business Name): ALI MOUSA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 ROSEDOWN DR
MONROE LA
71201-3083
US

IV. Provider business mailing address

2026 ROSEDOWN DR
MONROE LA
71201-3083
US

V. Phone/Fax

Practice location:
  • Phone: 318-237-3784
  • Fax:
Mailing address:
  • Phone: 318-237-3784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: