Provider Demographics
NPI:1437768314
Name:ALKHATIB, YAZAN (DDS)
Entity Type:Individual
Prefix:
First Name:YAZAN
Middle Name:
Last Name:ALKHATIB
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 1:730 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4525
Mailing Address - Country:US
Mailing Address - Phone:320-293-0831
Mailing Address - Fax:
Practice Address - Street 1:4948 34TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1504
Practice Address - Country:US
Practice Address - Phone:612-722-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist