Dr. Mamdouh Alrata, DDS
Dentist in Washington, MO. Individual provider (NPI-1).
NPI number1902321367
StatusActive
Last updated in NPPESFeb 1, 2022
Details
- NPI
- 1902321367
- Entity type
- Individual (NPI-1)
- Name
- Dr. Mamdouh Alrata
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 7, 2017
- Certification date
- Feb 1, 2022
- Last updated
- Feb 1, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - DENTIST
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 2020037677 | MO | Yes |
| 122300000X | Dentist | DE60694174 | WA |
Practice location
3155 Phoenix Center DrWashington, MO 63090-5689
Phone 630-550-7406
Mailing address
736 Carman Meadows DrManchester, MO 63021-7100
Phone 630-550-7406
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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