Provider Demographics
NPI:1720708431
Name:ALASSADI, MADI (DMD)
Entity type:Individual
Prefix:
First Name:MADI
Middle Name:
Last Name:ALASSADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10758 TRADITION VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1418
Mailing Address - Country:US
Mailing Address - Phone:704-779-9432
Mailing Address - Fax:
Practice Address - Street 1:10758 TRADITION VIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1418
Practice Address - Country:US
Practice Address - Phone:704-779-9432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty