Healthcare Provider Details

I. General information

NPI: 1457041550
Provider Name (Legal Business Name): NOURAH ABDUL KADER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 SAN PABLO AVE
ALBANY CA
94706-1126
US

IV. Provider business mailing address

591 SAN PABLO AVE APT 639
ALBANY CA
94706-1126
US

V. Phone/Fax

Practice location:
  • Phone: 313-447-9606
  • Fax:
Mailing address:
  • Phone: 313-447-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number111242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: