Provider Demographics
NPI:1679909022
Name:IFRAITEKH, ABDALLAH K (DMD)
Entity type:Individual
Prefix:DR
First Name:ABDALLAH
Middle Name:K
Last Name:IFRAITEKH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 HARBISON BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2226
Mailing Address - Country:US
Mailing Address - Phone:803-661-9529
Mailing Address - Fax:803-661-9783
Practice Address - Street 1:131 HARBISON BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2226
Practice Address - Country:US
Practice Address - Phone:803-661-9529
Practice Address - Fax:803-661-9783
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist