Healthcare Provider Details

I. General information

NPI: 1275497984
Provider Name (Legal Business Name): ALI SHAHRESTANI, D.M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BLUEFIELD RD STE A
MOORESVILLE NC
28117-7005
US

IV. Provider business mailing address

PO BOX 660041
DALLAS TX
75266-0041
US

V. Phone/Fax

Practice location:
  • Phone: 704-659-0972
  • Fax: 704-659-4439
Mailing address:
  • Phone: 714-845-8890
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALI SHAHRESTANI
Title or Position: OWNER
Credential: DMD
Phone: 704-659-0972