Healthcare Provider Details

I. General information

NPI: 1922676535
Provider Name (Legal Business Name): REEVES ABI-NAHED DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 TIERRA DEL REY STE 207
CHULA VISTA CA
91910-7865
US

IV. Provider business mailing address

5925 LINDA VISTA RD APT 1155
SAN DIEGO CA
92110-7414
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-1992
  • Fax:
Mailing address:
  • Phone: 858-242-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. GENEVIEVE ABI-NAHED
Title or Position: OWNER
Credential: DMD
Phone: 858-242-8223