Provider Demographics
NPI:1760053268
Name:AL TIKRITI, ABDULWAHAB TALAT (DMD)
Entity Type:Individual
Prefix:
First Name:ABDULWAHAB
Middle Name:TALAT
Last Name:AL TIKRITI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CROWN DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5474
Mailing Address - Country:US
Mailing Address - Phone:469-345-5392
Mailing Address - Fax:
Practice Address - Street 1:1 CROWN DR UNIT 101
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5474
Practice Address - Country:US
Practice Address - Phone:469-345-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist