Healthcare Provider Details

I. General information

NPI: 1114605938
Provider Name (Legal Business Name): SARA JAN ALI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 SECAUCUS RD
JERSEY CITY NJ
07307-2565
US

IV. Provider business mailing address

741 SECAUCUS RD
JERSEY CITY NJ
07307-2565
US

V. Phone/Fax

Practice location:
  • Phone: 201-754-1100
  • Fax:
Mailing address:
  • Phone: 201-754-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03057800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124106
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: