Healthcare Provider Details

I. General information

NPI: 1790701308
Provider Name (Legal Business Name): HANI M ABOUFOUL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ROZZELLES FERRY RD
CHARLOTTE NC
28208-4228
US

IV. Provider business mailing address

1801 ROZZELLES FERRY RD
CHARLOTTE NC
28208-4228
US

V. Phone/Fax

Practice location:
  • Phone: 704-350-7300
  • Fax: 704-350-7304
Mailing address:
  • Phone: 704-350-7300
  • Fax: 704-350-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberNC6417
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: