MEDICARE: NOURA FADEL D.D.S. FAGD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	103342	CA
2	125K00000X	Advanced Practice Dental Therapist	103342	CA

General Provider Information

NPI Number	:	1881826931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOURA FADEL D.D.S. FAGD

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	:	585-770-0592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	10/22/2024

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