Provider Demographics
NPI:1871834481
Name:ABDALLA, ROWIDA (DDS)
Entity Type:Individual
Prefix:
First Name:ROWIDA
Middle Name:
Last Name:ABDALLA
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 1:700 TIVERTON AVE BLDG 8-240
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-8361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 TIVERTON AVE BLDG 8-240
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0297
Practice Address - Country:US
Practice Address - Phone:310-794-6253
Practice Address - Fax:310-206-5553
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106135122300000X
KY95691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist