MEDICARE: REIAZ BEN ALI D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	11360	MD

General Provider Information

NPI Number	:	1104066257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REIAZ BEN ALI D.D.S., M.S.

Provider Business Mailing Address
First Line	:	7900 OLD BRANCH AVE
Second Line	:	SUITE 209
City	:	CLINTON
State	:	MD
Zip	:	20735
Country	:	US
Telephone Number	:	301-856-1200
Fax Number	:	301-868-1947

Provider Business Practice Location Address
First Line	:	7900 OLD BRANCH AVE
Second Line	:	SUITE 209
City	:	CLINTON
State	:	MD
Zip	:	20735
Country	:	US
Telephone Number	:	301-856-1200
Fax Number	:	301-868-1947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	05/25/2021

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