Healthcare Provider Details

I. General information

NPI: 1912525072
Provider Name (Legal Business Name): ALI ADIL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 FAIRFAX DR STE 640
ARLINGTON VA
22203-1626
US

IV. Provider business mailing address

7699 PALMILLA DR APT 3314
SAN DIEGO CA
92122-5097
US

V. Phone/Fax

Practice location:
  • Phone: 703-940-3070
  • Fax:
Mailing address:
  • Phone: 925-577-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number106739
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401418894
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: