Healthcare Provider Details

I. General information

NPI: 1619818044
Provider Name (Legal Business Name): FEDEL NASSR ALI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 28TH ST SW
WYOMING MI
49509-2855
US

IV. Provider business mailing address

4589 WESTLAND ST
DEARBORN MI
48126-2834
US

V. Phone/Fax

Practice location:
  • Phone: 616-530-9900
  • Fax:
Mailing address:
  • Phone: 313-398-4269
  • 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 StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: