Provider Demographics
NPI:1326359209
Name:AL-ABDULLA DDS INC
Entity type:Organization
Organization Name:AL-ABDULLA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-768-1671
Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:26B
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-768-1671
Mailing Address - Fax:949-768-1691
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:26B
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4342
Practice Address - Country:US
Practice Address - Phone:949-768-1671
Practice Address - Fax:949-768-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41337332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6363340001Medicare NSC