Provider Demographics
NPI:1700510492
Name:ALDOUSARI, ABDULLATIF (DDS)
Entity Type:Individual
Prefix:
First Name:ABDULLATIF
Middle Name:
Last Name:ALDOUSARI
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 1:9195 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2027
Mailing Address - Country:US
Mailing Address - Phone:804-823-5500
Mailing Address - Fax:804-980-7499
Practice Address - Street 1:9195 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2027
Practice Address - Country:US
Practice Address - Phone:804-823-5500
Practice Address - Fax:804-980-7499
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist