Healthcare Provider Details

I. General information

NPI: 1861327488
Provider Name (Legal Business Name): NOUR S FOUAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 PLEASANT VALLEY RD
FAIRMONT WV
26554-9456
US

IV. Provider business mailing address

2012 PLEASANT VALLEY RD
FAIRMONT WV
26554-9456
US

V. Phone/Fax

Practice location:
  • Phone: 304-368-0342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4874
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: