Basic Information
| Provider Information | |||||||||
| NPI: | 1942669312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALZWAIDEH | ||||||||
| FirstName: | RAKAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 55TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112202508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186307284 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7625 VIA CAMPANILE STE 130 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920098489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606331653 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2016 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 059332-1 | NY | N | Dental Providers | Dentist | 1223E0200X | DDS103857 | CA | N | Dental Providers | Dentist | Endodontics | 1223E0200X | 103857 | CA | Y | Dental Providers | Dentist | Endodontics |
No ID Information.