Provider Demographics
NPI:1225617871
Name:ALTAWASHI, EYAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EYAD
Middle Name:
Last Name:ALTAWASHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-8947
Mailing Address - Country:US
Mailing Address - Phone:734-243-1200
Mailing Address - Fax:734-457-9735
Practice Address - Street 1:2165 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-8947
Practice Address - Country:US
Practice Address - Phone:734-243-1200
Practice Address - Fax:734-457-9735
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600930122300000X
OH30.026432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist