Provider Demographics
NPI:1669902615
Name:ALOTAIBI, FAWWAZ FAIZ
Entity type:Individual
Prefix:
First Name:FAWWAZ
Middle Name:FAIZ
Last Name:ALOTAIBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FAWWAZ
Other - Middle Name:
Other - Last Name:ALOTAIBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DENTIST
Mailing Address - Street 1:6161 EDSALL RD APT 1608
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4141
Mailing Address - Country:US
Mailing Address - Phone:404-431-9587
Mailing Address - Fax:
Practice Address - Street 1:6161 EDSALL RD APT 1608
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4141
Practice Address - Country:US
Practice Address - Phone:404-431-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3917-17122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist