Provider Demographics
NPI:1013943612
Name:ABDELNOUR, JOE W (DDS MS)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:W
Last Name:ABDELNOUR
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 PALMA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442
Mailing Address - Country:US
Mailing Address - Phone:928-763-1203
Mailing Address - Fax:928-758-1072
Practice Address - Street 1:1467 PALMA ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:928-763-1203
Practice Address - Fax:928-758-1072
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD45371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ34223BOtherAAHCCS
67372Medicare ID - Type Unspecified
AZ34223BOtherAAHCCS