Provider Demographics
NPI:1356014633
Name:ALTEKREETI, TUKA
Entity Type:Individual
Prefix:
First Name:TUKA
Middle Name:
Last Name:ALTEKREETI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 GALLOWS RD APT 423
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7167
Mailing Address - Country:US
Mailing Address - Phone:859-494-0620
Mailing Address - Fax:
Practice Address - Street 1:14337 NEWBROOK DR STE 200
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4259
Practice Address - Country:US
Practice Address - Phone:703-214-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014175891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice