Individual provider Active NPI

Sanah Ali, DMD

  • Dentist
  • Tahlequah, OK
National Provider Identifier
1083963003
Registry record updated Jul 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6770 Issued in OK
Practice address
1200 W 4TH St
Tahlequah, OK 74464-5013
Phone
(918) 458-9100
NPI assigned
Sep 5, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6770 OK Primary
General Practice Dentistry 1223G0001X 28296 TX

Addresses

Primary practice location

1200 W 4TH St
Tahlequah, OK 74464-5013

Mailing address

1200 W 4TH St
Tahlequah, OK 74464-5013
Phone (918) 458-9100

Other names 1

  • Sana Ali Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170406000553 OK Order and Referring Only - DentistPractitioner - Dentist 8921384975

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28296TXMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468022400000",
    "number": "1083963003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W 4TH ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645013",
            "telephone_number": "918-458-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W 4TH ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645013",
            "telephone_number": "918-458-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALI",
        "first_name": "SANAH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2016-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "6770",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "28296",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANA",
            "last_name": "ALI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.