Provider Demographics
NPI:1073235891
Name:ALATTAR, AMMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMMAR
Middle Name:
Last Name:ALATTAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N 18TH ST APT 233
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3898
Mailing Address - Country:US
Mailing Address - Phone:267-270-0586
Mailing Address - Fax:
Practice Address - Street 1:6573 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2918
Practice Address - Country:US
Practice Address - Phone:267-515-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist