Provider Demographics
NPI:1437881448
Name:ALDUJAIL, RAWAA
Entity Type:Individual
Prefix:
First Name:RAWAA
Middle Name:
Last Name:ALDUJAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5006
Mailing Address - Country:US
Mailing Address - Phone:618-465-5727
Mailing Address - Fax:618-465-5504
Practice Address - Street 1:3430 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5006
Practice Address - Country:US
Practice Address - Phone:618-465-5727
Practice Address - Fax:618-465-5504
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019033716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist