Provider Demographics
NPI:1295474369
Name:MAHDI, ALI N (DDS)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:N
Last Name:MAHDI
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 1:302 N 3RD ST APT 720
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-1878
Mailing Address - Country:US
Mailing Address - Phone:816-209-8664
Mailing Address - Fax:
Practice Address - Street 1:4111 BROADWAY UNIT 611
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3527
Practice Address - Country:US
Practice Address - Phone:816-209-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022018908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist