MEDICARE: SYED ALI SHAREEF DDS

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	261QS1000X	Student Health Clinic/Center		AZ
2	122300000X	Dentist	D011117	AZ

General Provider Information

NPI Number	:	1467029983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED ALI SHAREEF DDS

Provider Business Mailing Address
First Line	:	1139 E PECAN ORCHARD LOOP
Second Line	:
City	:	SAHUARITA
State	:	AZ
Zip	:	85629-6726
Country	:	US
Telephone Number	:	520-838-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	9725 N THORNYDALE RD STE 173
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-5027
Country	:	US
Telephone Number	:	520-200-0177
Fax Number	:

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

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	07/16/2021

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