Provider Demographics
NPI:1235460916
Name:AL-ABDULLA, ANGHAM (DDS)
Entity Type:Individual
Prefix:
First Name:ANGHAM
Middle Name:
Last Name:AL-ABDULLA
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 1:24953 PASEO DE VALENCIA STE 26B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4341
Mailing Address - Country:US
Mailing Address - Phone:949-768-1671
Mailing Address - Fax:949-768-1691
Practice Address - Street 1:24953 PASEO DE VALENCIA STE 26B
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4341
Practice Address - Country:US
Practice Address - Phone:949-768-1671
Practice Address - Fax:949-768-1691
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6363340001Medicare NSC