Provider Demographics
NPI:1912525072
Name:ADIL, ALI (DDS)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:ADIL
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 1:7699 PALMILLA DR APT 3314
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5097
Mailing Address - Country:US
Mailing Address - Phone:925-577-8552
Mailing Address - Fax:
Practice Address - Street 1:4350 FAIRFAX DR STE 640
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1626
Practice Address - Country:US
Practice Address - Phone:703-940-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106739122300000X
390200000X
VA04014188941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program