Individual
KHALED ALTABTBAEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 W 12TH AVE, 2ND FLOOR, GRADUATE RESIDENT PERIODONTOLOGY CLINICS, COLUMBUS, OH 43210-1267
(614) 688-3763
Mailing address
305 W 12TH AVE, DEPARTMENT OF PERIODONTOLOGY, 4TH FLOOR, COLUMBUS, OH 43210-1267
(614) 292-0371
(614) 292-4612
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
RES.3377
OH
Other
Enumeration date
11/20/2014
Last updated
05/11/2015
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