Provider Demographics
NPI:1366178410
Name:ALTEKREETI, ABDULRAHMAN
Entity type:Individual
Prefix:
First Name:ABDULRAHMAN
Middle Name:
Last Name:ALTEKREETI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 VICTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2216
Mailing Address - Country:US
Mailing Address - Phone:859-693-9877
Mailing Address - Fax:
Practice Address - Street 1:10936 NORTH FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1108
Practice Address - Country:US
Practice Address - Phone:936-236-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist