Healthcare Provider Details

I. General information

NPI: 1366359077
Provider Name (Legal Business Name): ALI MOHAMAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 COPPER CLIFF CT
BLOOMFIELD HILLS MI
48302-1923
US

IV. Provider business mailing address

4315 COPPER CLIFF CT
BLOOMFIELD HILLS MI
48302-1923
US

V. Phone/Fax

Practice location:
  • Phone: 313-329-8889
  • Fax:
Mailing address:
  • Phone: 313-329-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: