Provider Demographics
NPI:1487000592
Name:ALQADOUMI, THAER BASIM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:THAER
Middle Name:BASIM
Last Name:ALQADOUMI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81735 US HIGHWAY 111
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-0713
Mailing Address - Country:US
Mailing Address - Phone:760-238-4533
Mailing Address - Fax:
Practice Address - Street 1:81735 US HIGHWAY 111
Practice Address - Street 2:SUITE A
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-0713
Practice Address - Country:US
Practice Address - Phone:760-238-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100200122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist