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General NPI Number Information
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NPI Number | 1477109486
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Entity Type | Individual
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Provider Name | ALI ALTAK
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Gender | Male
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 520 N 12TH ST
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City | RICHMOND
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State | VA
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Zip | 23298-5064
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Country | US
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Telephone | 336-355-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 1521 E FRANKLIN ST APT B202
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City | CHAPEL HILL
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State | NC
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Zip | 27514-2804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 151262
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12982
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 0442000563
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License Number State | VA
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