MEDICARE: DR. ALI B. ALSARAJ DMD

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	1223G0001X	General Practice Dentistry	12012725A	IN

General Provider Information

NPI Number	:	1992233142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI B. ALSARAJ DMD

Provider Business Mailing Address
First Line	:	12903 DEKOVEN DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-7700
Country	:	US
Telephone Number	:	806-881-9034
Fax Number	:

Provider Business Practice Location Address
First Line	:	8137 PENDLETON PIKE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-4014
Country	:	US
Telephone Number	:	317-593-2500
Fax Number	:	317-234-2054

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

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	06/01/2017

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