Provider Demographics
NPI:1013284553
Name:ABUFARWA, MOUFIDA (BDS MS MS PHD)
Entity Type:Individual
Prefix:DR
First Name:MOUFIDA
Middle Name:
Last Name:ABUFARWA
Suffix:
Gender:F
Credentials:BDS MS MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3479
Mailing Address - Country:US
Mailing Address - Phone:317-548-6262
Mailing Address - Fax:
Practice Address - Street 1:2248 E 53RD ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3479
Practice Address - Country:US
Practice Address - Phone:317-548-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL11457122300000X
IN12013725A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist