Individual
ALI ALTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(336) 355-4554
Mailing address
1521 E FRANKLIN ST APT B202, CHAPEL HILL, NC 27514-2804
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12982
NC
122300000X
Dentist
151262
NC
1223P0700X
Prosthodontics
Primary
0442000563
VA
Other
Enumeration date
08/15/2019
Last updated
07/14/2025
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