Provider Demographics
NPI:1700427978
Name:AL-RUBAYE, ALI AHMED
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:AHMED
Last Name:AL-RUBAYE
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 1:8 WASILLA DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2411
Mailing Address - Country:US
Mailing Address - Phone:978-905-1912
Mailing Address - Fax:
Practice Address - Street 1:285 MAIN ST # 5719
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5719
Practice Address - Country:US
Practice Address - Phone:617-207-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist