Provider Demographics
NPI:1194493080
Name:ABDULMAJEED, ALI DLAIR
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:DLAIR
Last Name:ABDULMAJEED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E WATERSIDE DR UNIT 704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4708
Mailing Address - Country:US
Mailing Address - Phone:832-373-2721
Mailing Address - Fax:
Practice Address - Street 1:5045 W BASELINE RD STE 135
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7394
Practice Address - Country:US
Practice Address - Phone:602-237-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190333851223G0001X
AZD0119321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice