Provider Demographics
NPI:1104273705
Name:ABDELMALAK, NEVIN SHENOUDA (DDS)
Entity type:Individual
Prefix:DR
First Name:NEVIN
Middle Name:SHENOUDA
Last Name:ABDELMALAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 GREENWICH DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1206
Mailing Address - Country:US
Mailing Address - Phone:651-216-2175
Mailing Address - Fax:
Practice Address - Street 1:508 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2411
Practice Address - Country:US
Practice Address - Phone:651-216-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103378122300000X
MND13700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist