Basic Information
| Provider Information | |||||||||
| NPI: | 1366817884 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RASHAD M. ALTAWATY DDS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3189 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132203189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154546000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8143 AGORA PKWY | ||||||||
| Address2: | STE 105 | ||||||||
| City: | SELMA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781541341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106596622 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2015 | ||||||||
| LastUpdateDate: | 04/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | ALTAWATY | ||||||||
| AuthorizedOfficialFirstName: | RASHAD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2546900092 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 30361 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.