Provider Demographics
NPI:1962775023
Name:CRESCENT DENTAL CARE
Entity type:Organization
Organization Name:CRESCENT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-762-2020
Mailing Address - Street 1:8056 N MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1609
Mailing Address - Country:US
Mailing Address - Phone:734-762-2020
Mailing Address - Fax:734-762-2090
Practice Address - Street 1:8056 N MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1609
Practice Address - Country:US
Practice Address - Phone:734-762-2020
Practice Address - Fax:734-762-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty