Provider Demographics
NPI:1578311098
Name:KHATTAR ALMHITHAWI, BAHER (DDS)
Entity type:Individual
Prefix:DR
First Name:BAHER
Middle Name:
Last Name:KHATTAR ALMHITHAWI
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 1:13855 IBIS POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1394
Mailing Address - Country:US
Mailing Address - Phone:904-999-7566
Mailing Address - Fax:
Practice Address - Street 1:4071 LEE RD STE 260
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2173
Practice Address - Country:US
Practice Address - Phone:216-727-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0047521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice