Healthcare Provider Details

I. General information

NPI: 1407853690
Provider Name (Legal Business Name): AMAL ABIAOUI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 E FRONT ST
BUTTONWILLOW CA
93206
US

IV. Provider business mailing address

659 S CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

V. Phone/Fax

Practice location:
  • Phone: 661-764-5257
  • Fax:
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: