Provider Demographics
NPI:1508551904
Name:DARALSHEIKH, MUATH A
Entity Type:Individual
Prefix:
First Name:MUATH
Middle Name:A
Last Name:DARALSHEIKH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 INDIANAPOLIS BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-4204
Mailing Address - Country:US
Mailing Address - Phone:219-244-6643
Mailing Address - Fax:
Practice Address - Street 1:322 INDIANAPOLIS BLVD STE 106
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-4204
Practice Address - Country:US
Practice Address - Phone:219-244-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190342631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice