Healthcare Provider Details

I. General information

NPI: 1992106397
Provider Name (Legal Business Name): ALI JAVAID DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MUHAMMAD ALI JAVAID

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 SOUTHWEST FWY 570
SUGAR LAND TX
77479-2321
US

IV. Provider business mailing address

552 BROAD AVE
ENGLEWOOD NJ
07631-5011
US

V. Phone/Fax

Practice location:
  • Phone: 954-846-7171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30430
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: