MEDICARE: NOURA FADEL RATEB DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
4	1223X2210X	Orofacial Pain Dentistry
5	125K00000X	Advanced Practice Dental Therapist

General Provider Information

NPI Number	:	1679216253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURA FADEL RATEB DDS INC

Provider Business Mailing Address
First Line	:	720 BROOKSIDE AVE STE 100
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5189
Country	:	US
Telephone Number	:	909-488-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 BROOKSIDE AVE STE 100
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5189
Country	:	US
Telephone Number	:	909-488-0222
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. NOURA SEIF ALLAH AHMED FADEL RATEB
Credential	:	DDS FAGD
Telephone Number	:	585-770-0592

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	04/20/2022

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