Provider Demographics
NPI:1174795751
Name:ALKHATIB, ABED (DMD)
Entity type:Individual
Prefix:DR
First Name:ABED
Middle Name:
Last Name:ALKHATIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1804
Mailing Address - Country:US
Mailing Address - Phone:203-371-5595
Mailing Address - Fax:203-372-4912
Practice Address - Street 1:4747 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1804
Practice Address - Country:US
Practice Address - Phone:203-371-5595
Practice Address - Fax:203-372-4912
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0098421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery