Provider Demographics
NPI:1073008959
Name:ABDELRAHMAN, MARWA ALY ABDELHAMID (BDS, MSD)
Entity Type:Individual
Prefix:
First Name:MARWA
Middle Name:ALY ABDELHAMID
Last Name:ABDELRAHMAN
Suffix:
Gender:F
Credentials:BDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15144 NW COSMOS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7058
Mailing Address - Country:US
Mailing Address - Phone:502-408-9744
Mailing Address - Fax:
Practice Address - Street 1:1789 NW 173RD AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4817
Practice Address - Country:US
Practice Address - Phone:503-614-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORD116951223P0221X
OH30.0262921223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice