Provider Demographics
NPI:1669030953
Name:EL NABOULSY, MARAWAN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MARAWAN
Middle Name:
Last Name:EL NABOULSY
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 2ND AVE N UNIT 1502
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3746
Mailing Address - Country:US
Mailing Address - Phone:949-584-4199
Mailing Address - Fax:
Practice Address - Street 1:1820 GADSDEN HWY STE 112
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3205
Practice Address - Country:US
Practice Address - Phone:949-584-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH30.025896390200000X
ALD.007367-C1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program