Healthcare Provider Details

I. General information

NPI: 1881826931
Provider Name (Legal Business Name): NOURA FADEL D.D.S. FAGD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
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: 585-770-0592
  • Fax:
Mailing address:
  • Phone: 909-488-0222
  • Fax: 909-300-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125K00000X
TaxonomyAdvanced Practice Dental Therapist
License Number103342
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number103342
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number103342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: