Provider Demographics
NPI:1134568884
Name:ALKHADER, FERAS TAHER (DDS)
Entity type:Individual
Prefix:DR
First Name:FERAS
Middle Name:TAHER
Last Name:ALKHADER
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 1:1721 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-4937
Mailing Address - Country:US
Mailing Address - Phone:256-499-0080
Mailing Address - Fax:
Practice Address - Street 1:2207 GUNNELLS LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-3613
Practice Address - Country:US
Practice Address - Phone:256-499-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001020-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist