Provider Demographics
NPI:1427898295
Name:MOHAMMED ALI, AHMED MUWAFAQ (DDS)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MUWAFAQ
Last Name:MOHAMMED 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 1:505 E ALCOTT ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-6144
Mailing Address - Country:US
Mailing Address - Phone:269-349-2641
Mailing Address - Fax:
Practice Address - Street 1:505 E ALCOTT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-6144
Practice Address - Country:US
Practice Address - Phone:832-310-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist