MEDICARE: OURAY DENTAL LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1265252365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OURAY DENTAL LLC

Provider Business Mailing Address
First Line	:	6742 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-1619
Country	:	US
Telephone Number	:	614-319-3154
Fax Number	:

Provider Business Practice Location Address
First Line	:	6742 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-1619
Country	:	US
Telephone Number	:	614-319-3154
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HAIDER ALMALIKI
Credential	:	DDS
Telephone Number	:	202-390-1921

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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Directions to “OURAY DENTAL LLC ” Practice Location

Language	Start Address	Practice Location

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