Provider Demographics
NPI:1477220580
Name:ELKHATIB, ALAA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAA
Middle Name:
Last Name:ELKHATIB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 E MAIN ST APT 1804
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3316
Mailing Address - Country:US
Mailing Address - Phone:804-539-2115
Mailing Address - Fax:
Practice Address - Street 1:18121 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2921
Practice Address - Country:US
Practice Address - Phone:804-589-1491
Practice Address - Fax:804-589-1494
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417658122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist