Healthcare Provider Details

I. General information

NPI: 1063603405
Provider Name (Legal Business Name): BASSEM ALKATIB DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NATIVE TRL
IRVINE CA
92618-8855
US

IV. Provider business mailing address

43 NATIVE TRL
IRVINE CA
92618-8855
US

V. Phone/Fax

Practice location:
  • Phone: 310-634-5378
  • Fax:
Mailing address:
  • Phone: 310-634-5378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number55998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: