Provider Demographics
NPI:1700605698
Name:ALMUTAIRI, EMAN
Entity type:Individual
Prefix:
First Name:EMAN
Middle Name:
Last Name:ALMUTAIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 WILLAMETTE DR NE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-1443
Mailing Address - Country:US
Mailing Address - Phone:352-888-3734
Mailing Address - Fax:
Practice Address - Street 1:3240 WILLAMETTE DR NE UNIT 102
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-1443
Practice Address - Country:US
Practice Address - Phone:352-888-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE615606161223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics