Provider Demographics
NPI:1326351974
Name:MOATTAR, ALI-RAAD (DDS)
Entity Type:Individual
Prefix:
First Name:ALI-RAAD
Middle Name:
Last Name:MOATTAR
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 1:19039 NORDHOFF ST
Mailing Address - Street 2:APT. 211
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4808
Mailing Address - Country:US
Mailing Address - Phone:310-775-0494
Mailing Address - Fax:
Practice Address - Street 1:19039 NORDHOFF ST
Practice Address - Street 2:APT. 211
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4808
Practice Address - Country:US
Practice Address - Phone:310-775-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist