Healthcare Provider Details

I. General information

NPI: 1114037470
Provider Name (Legal Business Name): ADEL RASMY TAWFILIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12264 EL CAMINO REAL SUITE 111
SAN DIEGO CA
92130-3058
US

IV. Provider business mailing address

12264 EL CAMINO REAL SUITE 111
SAN DIEGO CA
92130-3058
US

V. Phone/Fax

Practice location:
  • Phone: 858-509-1259
  • Fax: 858-509-0912
Mailing address:
  • Phone: 858-509-1259
  • Fax: 858-509-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number42008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: