Individual
AL HAITHAM AL SHETAWI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
45 READE PL, DYSON CENTER, 3RD FLOOR, POUGHKEEPSIE, NY 12601-3947
(845) 483-6920
Mailing address
1351 ROUTE 55, SUITE 200, LAGRANGEVILLE, NY 12540-5128
(845) 475-9661
(845) 475-9938
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
054793
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
054793
NY
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
282208
NY
Other
Enumeration date
05/14/2008
Last updated
07/21/2022
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