Provider Demographics
NPI:1881826931
Name:FADEL RATEB, NOURA (DDS FAGD)
Entity Type:Individual
Prefix:
First Name:NOURA
Middle Name:
Last Name:FADEL RATEB
Suffix:
Gender:F
Credentials:DDS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BROOKSIDE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5189
Mailing Address - Country:US
Mailing Address - Phone:909-488-0222
Mailing Address - Fax:
Practice Address - Street 1:720 BROOKSIDE AVE STE 100
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5189
Practice Address - Country:US
Practice Address - Phone:585-770-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103342125K00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No122300000XDental ProvidersDentist