Provider Demographics
NPI:1194958157
Name:AL-ALI, TAREQ (DDS)
Entity type:Individual
Prefix:
First Name:TAREQ
Middle Name:
Last Name:AL-ALI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E CARY ST APT 214
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7085
Mailing Address - Country:US
Mailing Address - Phone:804-564-1561
Mailing Address - Fax:
Practice Address - Street 1:2222 E CARY ST APT 214
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7085
Practice Address - Country:US
Practice Address - Phone:804-564-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist