Individual
NIDA ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21312 CHESTERFIELD AVE, SOUTH CHESTERFIELD, VA 23803-2406
(804) 526-2424
Mailing address
18400 MAGNOLIA RUN LN, MOSELEY, VA 23120-1930
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401418564
VA
Other
Enumeration date
07/03/2023
Last updated
08/04/2024
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