Healthcare Provider Details

I. General information

NPI: 1770080970
Provider Name (Legal Business Name): AATIQAH AAKIFAH KHALID DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10964 RIVER RD
SAINT ROSE LA
70087-3400
US

IV. Provider business mailing address

5 CHATEAU MOUTON DR
KENNER LA
70065-1902
US

V. Phone/Fax

Practice location:
  • Phone: 504-469-9778
  • Fax:
Mailing address:
  • Phone: 919-475-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6992
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: