Basic Information
| Provider Information | |||||||||
| NPI: | 1265751937 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALI | ||||||||
| FirstName: | USMAN | ||||||||
| MiddleName: | SHAUKAT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 503 MUIR ST STE A | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216131848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102289381 | ||||||||
| FaxNumber: | 8339161011 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 MUIR ST STE A | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216131848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102289381 | ||||||||
| FaxNumber: | 8339161011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2010 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 056395 | NY | N | Dental Providers | Dentist | Pediatric Dentistry | 1223P0221X | LL844 | MD | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.