Provider Demographics
NPI:1578301263
Name:MAKLED, MOHAMMED ALI (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:ALI
Last Name:MAKLED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 BEECHMONT ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1516
Mailing Address - Country:US
Mailing Address - Phone:313-590-3440
Mailing Address - Fax:
Practice Address - Street 1:36700 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3770
Practice Address - Country:US
Practice Address - Phone:313-590-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016022881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice