Healthcare Provider Details

I. General information

NPI: 1184987075
Provider Name (Legal Business Name): YASSER ALALI BDS, DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2012
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 NORTH TELEGRAPH ROAD
DEARBORN MI
48128
US

IV. Provider business mailing address

430 NORTH TELEGRAPH ROAD
DEARBORN MI
48128
US

V. Phone/Fax

Practice location:
  • Phone: 313-563-6601
  • Fax:
Mailing address:
  • Phone: 313-563-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901020729
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: