Provider Demographics
NPI:1730867136
Name:ALKHATIB, ABDULRAHMAN MOHAMMAD (DDS)
Entity type:Individual
Prefix:DR
First Name:ABDULRAHMAN
Middle Name:MOHAMMAD
Last Name:ALKHATIB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16527 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5355
Mailing Address - Country:US
Mailing Address - Phone:708-307-1448
Mailing Address - Fax:
Practice Address - Street 1:8021 W 79TH ST
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-1607
Practice Address - Country:US
Practice Address - Phone:708-634-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist