Provider Demographics
NPI:1043935125
Name:ALTITINCHI, ALI WAADALLAH
Entity type:Individual
Prefix:MR
First Name:ALI
Middle Name:WAADALLAH
Last Name:ALTITINCHI
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 1:5310 N TARRANT PARKWAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORTWORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:817-849-9777
Mailing Address - Fax:
Practice Address - Street 1:5310 N TARRANT PARKWAY
Practice Address - Street 2:SUITE 106
Practice Address - City:FORTWORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-849-9777
Practice Address - Fax:205-975-4431
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX408851223E0200X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics