MEDICARE: ABDULRAHMAN ALTEKREETI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	38843	TX

General Provider Information

NPI Number	:	1366178410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDULRAHMAN ALTEKREETI

Provider Business Mailing Address
First Line	:	385 VICTORIA BLVD
Second Line	:
City	:	KENMORE
State	:	NY
Zip	:	14217-2216
Country	:	US
Telephone Number	:	859-693-9877
Fax Number	:

Provider Business Practice Location Address
First Line	:	10936 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1108
Country	:	US
Telephone Number	:	936-236-9566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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