Mazen Khaled Aly, BDS, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901601632 Issued in MI

Practice address

4860 Washtenaw Ave Ste D
Ann Arbor, MI 48108-3401

Phone

(734) 263-7545

NPI assigned

Jul 7, 2022

Last updated

Jul 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1407589344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4860 WASHTENAW AVE STE D",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481083401",
            "telephone_number": "734-263-7545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4860 WASHTENAW AVE STE D",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481083401",
            "telephone_number": "734-263-7545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5979 Highland Rd",
            "address_purpose": "LOCATION",
            "city": "Waterford Township",
            "state": "MI",
            "postal_code": "48327",
            "country_code": "US",
            "telephone_number": "947-999-9909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALY",
        "first_name": "MAZEN",
        "middle_name": "KHALED",
        "name_prefix": "Dr.",
        "credential": "BDS, DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-07",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901601632",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "ETN960",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Nicole Alvarado, MS, RDN
• Samantha Alvarado
• Cristina Alvardo Nieves, M.D.
• Marissa Alvarez, LLMSW, MPH
• Rasheed Alwan
• Daniel Michael Alyesh, MD
• Alyssa Selasky LMSW
• Shadi Alzahrani, BDS
• Jason Mallo Amador, CRNA
• Amanda and Company Counseling LLC

• Dentist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.