Provider Demographics
NPI:1184389835
Name:KATTOOF, ALYAA HUSSEIN (BDS,MS)
Entity type:Individual
Prefix:
First Name:ALYAA
Middle Name:HUSSEIN
Last Name:KATTOOF
Suffix:
Gender:F
Credentials:BDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 CROCKETT RD STE B
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5908
Mailing Address - Country:US
Mailing Address - Phone:903-723-4223
Mailing Address - Fax:
Practice Address - Street 1:2014 CROCKETT RD STE B
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5908
Practice Address - Country:US
Practice Address - Phone:903-723-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37898OtherTEXAS STATE BOARD OF DENTAL EXAMINERS