Provider Demographics
NPI:1144555079
Name:ALATTAR, MAHDI
Entity type:Individual
Prefix:
First Name:MAHDI
Middle Name:
Last Name:ALATTAR
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 1:115 W BROAD ST
Mailing Address - Street 2:APT 404
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4276
Mailing Address - Country:US
Mailing Address - Phone:804-874-5788
Mailing Address - Fax:
Practice Address - Street 1:14346 WARWICK BLVD STE 418
Practice Address - Street 2:# 418
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-3817
Practice Address - Country:US
Practice Address - Phone:757-886-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014126281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice