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General NPI Number Information
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NPI Number | 1316419351
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Entity Type | Individual
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Provider Name | MINA FOUAD DDS
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Gender | Male
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 7860 WEST LN
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City | STOCKTON
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State | CA
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Zip | 95210-3317
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Country | US
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Telephone | 209-235-0295
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Fax |
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Provider Business Mailing Address
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Address Line | 6 OAKWOOD PL
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-2321
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Country | US
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Telephone | 973-757-4299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103452
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License Number State | CA
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