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NPI Code Detail

MEDICARE: DR. ALI NOORI DAHAM DDS

MEDICARE: DR. ALI NOORI DAHAM 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
11223G0001XGeneral Practice Dentistry39366TX

General Provider Information

NPI Number : 1740913938
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALI NOORI DAHAM DDS
Provider Business Mailing Address
First Line : 11666 N 28TH DR UNIT 139
Second Line :
City : PHOENIX
State : AZ
Zip : 85029-5618
Country : US
Telephone Number : 323-980-6661
Fax Number :
Provider Business Practice Location Address
First Line : 5665 HIGHWAY 95 N
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86404-9646
Country : US
Telephone Number : 323-980-6661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2022
Last Update Date : 05/23/2023

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