Provider Demographics
NPI:1558624569
Name:ABUALSOUD, ARWA (DMD)
Entity Type:Individual
Prefix:
First Name:ARWA
Middle Name:
Last Name:ABUALSOUD
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 1:517 ALDERBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-4795
Mailing Address - Country:US
Mailing Address - Phone:859-806-4361
Mailing Address - Fax:
Practice Address - Street 1:3904 HULL STREET RD
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1714
Practice Address - Country:US
Practice Address - Phone:804-233-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401413656OtherLICENSE NUMBER