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Provider Information for 1417204918

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

HISHAM ALKHATEEB D.D.S.

Gender: MALE

Individual NPI: 1417204918

Calendar   Last Updated:  2012-08-14
  Certification Date: 

Details

Name Value
NPI 1417204918
Enumeration Date 2012-08-14
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 267 E 17TH ST
COSTA MESA, CA 92627-3831
United States

Phone: 949-646-2411 | Fax: 949-646-9141
View Map External Link
Primary Practice Address 267 E 17TH ST
COSTA MESA, CA 92627-3831
United States

Phone: 949-646-2411 | Fax: 949-646-9141
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 41699