Healthcare Provider Details

I. General information

NPI: 1356939466
Provider Name (Legal Business Name): LEEN MOHAMMAD AHMAD ALQUDAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 S COLUMBIA ST
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

1401 MASON FARM RD
CHAPEL HILL NC
27514-4614
US

V. Phone/Fax

Practice location:
  • Phone: 984-999-8811
  • Fax:
Mailing address:
  • Phone: 984-999-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number51310
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: