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General NPI Number Information
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NPI Number | 1336642636
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Entity Type | Individual
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Provider Name | DEYAAEDDIN ALI ALNAAS
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Gender | Male
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 6297 DIXIE HWY
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City | BRIDGEPORT
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State | MI
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Zip | 48722-9635
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Country | US
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Telephone | 989-921-5390
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Fax | 989-399-8266
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Provider Business Mailing Address
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Address Line | 11 S MILL ST STE 200
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City | NEW CASTLE
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State | PA
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Zip | 16101-3680
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 040415918
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901022482
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License Number State | MI
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