Healthcare Provider Details

I. General information

NPI: 1679216253
Provider Name (Legal Business Name): NOURA FADEL RATEB DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BROOKSIDE AVE STE 100
REDLANDS CA
92373-5189
US

IV. Provider business mailing address

720 BROOKSIDE AVE STE 100
REDLANDS CA
92373-5189
US

V. Phone/Fax

Practice location:
  • Phone: 909-488-0222
  • Fax:
Mailing address:
  • Phone: 909-488-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NOURA SEIF ALLAH AHMED FADEL RATEB
Title or Position: CEO
Credential: DDS FAGD
Phone: 585-770-0592