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General NPI Number Information
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NPI Number | 1396195566
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Entity Type | Individual
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Provider Name | ALI FADEL MAHDY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 29525 CANWOOD ST STE 301
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4232
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Country | US
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Telephone | 818-706-0975
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 N WASHINGTON AVE
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City | DURANT
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State | OK
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Zip | 74701-2118
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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 | 6825
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License Number State | OK
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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 | 102341
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License Number State | CA
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