Provider Demographics
NPI:1992914980
Name:ALI, EJAZ (DMD)
Entity type:Individual
Prefix:DR
First Name:EJAZ
Middle Name:
Last Name:ALI
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 1:5 SEAWARD RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-7510
Mailing Address - Country:US
Mailing Address - Phone:781-237-9071
Mailing Address - Fax:
Practice Address - Street 1:5 SEAWARD RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-7510
Practice Address - Country:US
Practice Address - Phone:781-237-9071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
X11612OtherBLUE CROSS BLUE SHIELD