Provider Demographics
NPI:1720788136
Name:AL-BAYATTI, AHMED YOUSIF MOHAMMED (DDS)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:YOUSIF MOHAMMED
Last Name:AL-BAYATTI
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 1:2610 REYNOLDS RANCH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6890
Mailing Address - Country:US
Mailing Address - Phone:209-390-9379
Mailing Address - Fax:
Practice Address - Street 1:2610 REYNOLDS RANCH PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6890
Practice Address - Country:US
Practice Address - Phone:209-390-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1086411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice