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General NPI Number Information
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NPI Number | 1154486819
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Entity Type | Individual
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Provider Name | ISHAQ GHALEB ALI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/23/2006
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 9811 CONANT ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3877
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Country | US
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Telephone | 313-870-9423
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Fax |
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Provider Business Mailing Address
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Address Line | 31513 E SIANNA DR
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City | MARANA
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State | AZ
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Zip | 85658-8840
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Country | US
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Telephone | 520-400-0023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D7446
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License Number State | AZ
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