Provider Demographics
NPI:1801083803
Name:AUDI, AMAL MEKHAEL (DDS)
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:MEKHAEL
Last Name:AUDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2858
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92842-2858
Mailing Address - Country:US
Mailing Address - Phone:714-719-5024
Mailing Address - Fax:
Practice Address - Street 1:2300 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3518
Practice Address - Country:US
Practice Address - Phone:714-750-3030
Practice Address - Fax:714-971-0817
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist