Provider Demographics
NPI:1689418097
Name:ALI, MOHD-TAHA (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHD-TAHA
Middle Name:
Last Name: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 1:2500 MARKETPLACE DR APT 115
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-2433
Mailing Address - Country:US
Mailing Address - Phone:254-717-6495
Mailing Address - Fax:
Practice Address - Street 1:100 FORREST TER
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-6804
Practice Address - Country:US
Practice Address - Phone:903-938-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist