Healthcare Provider Details

I. General information

NPI: 1184588923
Provider Name (Legal Business Name): ABDALRAHMAN GABER MOHAMED ABDALLAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W OLIVE AVE STE 101
MERCED CA
95348-1939
US

IV. Provider business mailing address

2140 MORNING STAR LN
WINSTON SALEM NC
27107-6241
US

V. Phone/Fax

Practice location:
  • Phone: 209-205-4288
  • Fax:
Mailing address:
  • Phone: 510-401-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: