Provider Demographics
NPI:1922386473
Name:GHONIEM, NEEHAL GAMAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEEHAL
Middle Name:GAMAL
Last Name:GHONIEM
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 1:4604 TERRAZA MAR MARVELOSA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4675
Mailing Address - Country:US
Mailing Address - Phone:954-288-6696
Mailing Address - Fax:
Practice Address - Street 1:838 NORDAHL RD STE 145
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3513
Practice Address - Country:US
Practice Address - Phone:760-480-6700
Practice Address - Fax:760-480-6701
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010211801223G0001X
390200000X
CA617251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program