Healthcare Provider Details

I. General information

NPI: 1164374708
Provider Name (Legal Business Name): AHMED A ABDULWAHHAB AL-DAWOODI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19071 BEAR VALLEY RD
APPLE VALLEY CA
92308-2718
US

IV. Provider business mailing address

236 COYOTE DR
COLTON CA
92324-3721
US

V. Phone/Fax

Practice location:
  • Phone: 760-810-4066
  • Fax:
Mailing address:
  • Phone: 909-254-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: