Individual
BANO QUTUB ALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
41 ADMIRAL CALLAGHAN LN, VALLEJO, CA 94591-4000
(713) 922-1063
Mailing address
417 EVELYN AVE APT 201, ALBANY, CA 94706-1321
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
104200
CA
Other
Enumeration date
12/08/2019
Last updated
12/08/2019
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