Provider Demographics
NPI:1356645634
Name:ALALAWI, EJLAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:EJLAL
Middle Name:
Last Name:ALALAWI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14714 W WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2369
Mailing Address - Country:US
Mailing Address - Phone:914-325-5672
Mailing Address - Fax:
Practice Address - Street 1:14714 W WOODLAND DR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-2369
Practice Address - Country:US
Practice Address - Phone:914-325-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-31
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6477015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist