Provider Demographics
NPI:1134782287
Name:HAMADE, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:HAMADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 GREENFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-6003
Mailing Address - Country:US
Mailing Address - Phone:313-254-2141
Mailing Address - Fax:313-914-2078
Practice Address - Street 1:6150 GREENFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-6003
Practice Address - Country:US
Practice Address - Phone:313-254-2141
Practice Address - Fax:313-914-2078
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2023-11-10
Deactivation Date:2023-09-23
Deactivation Code:
Reactivation Date:2023-11-06
Provider Licenses
StateLicense IDTaxonomies
MI2901601835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist