Provider Demographics
NPI:1427796382
Name:FADUL, MOUADA ABDELLATIF ABDELAAL (DMD)
Entity type:Individual
Prefix:
First Name:MOUADA
Middle Name:ABDELLATIF ABDELAAL
Last Name:FADUL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 S 160TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2120
Mailing Address - Country:US
Mailing Address - Phone:252-481-1530
Mailing Address - Fax:
Practice Address - Street 1:4090 WESTOWN PKWY STE B1
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6760
Practice Address - Country:US
Practice Address - Phone:515-267-0737
Practice Address - Fax:515-267-1480
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-102671223G0001X, 1223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist