Individual provider · NPI-1

Ibrahim Mohmad Al-Qawaqneh, DDS

Dentist, General Practice · Anaheim, CA

NPI number1194805887
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1194805887
Entity type
Individual (NPI-1)
Name
Ibrahim Mohmad Al-Qawaqneh
Credential
DDS
Sex
Male
Sole proprietor
Yes
Enumeration date
Oct 17, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice46726CAYes

Practice location

1719 W Romneya Dr
Anaheim, CA 92801-1804

Phone 714-991-3900 · Fax 714-991-3999

Mailing address

1719 W Romneya Dr
Anaheim, CA 92801-1804

Phone 714-991-3900 · Fax 714-991-3999

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