Provider Demographics
NPI:1912381948
Name:ALTAMEEMI, ISRAA
Entity Type:Individual
Prefix:
First Name:ISRAA
Middle Name:
Last Name:ALTAMEEMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 N CARON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-9633
Mailing Address - Country:US
Mailing Address - Phone:815-562-7582
Mailing Address - Fax:815-562-9742
Practice Address - Street 1:1223 N CARON RD
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-9633
Practice Address - Country:US
Practice Address - Phone:815-562-7582
Practice Address - Fax:815-562-9742
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190303131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice