Provider Demographics
NPI:1649791898
Name:AL TEKREETI, MOHAMMED (DMD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:AL TEKREETI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 RANCHO MISSION RD UNIT 306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1822
Mailing Address - Country:US
Mailing Address - Phone:347-978-2264
Mailing Address - Fax:
Practice Address - Street 1:6175 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3915
Practice Address - Country:US
Practice Address - Phone:619-583-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist