Provider Demographics
NPI:1619126638
Name:ALTATARI, RABI MOHAMMAD (DDS)
Entity Type:Individual
Prefix:
First Name:RABI
Middle Name:MOHAMMAD
Last Name:ALTATARI
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 1:16629 E SMOKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1764
Mailing Address - Country:US
Mailing Address - Phone:303-699-8788
Mailing Address - Fax:303-699-9011
Practice Address - Street 1:16629 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1764
Practice Address - Country:US
Practice Address - Phone:303-699-8788
Practice Address - Fax:303-699-9011
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9747OtherSTATE OF COLORADO DENTAL LICENSE