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General NPI Number Information
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NPI Number | 1376957605
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Entity Type | Individual
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Provider Name | EZDEHAR GHANDOURAH PDS, MCS, FACP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2014
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Last Update Date | 06/14/2014
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Provider Practice Location Address
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Address Line | AL IMAM TURKI IBN ABDULLAH IBN MUHAMMAD, ULAISHAH
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City | RIYADH
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State | CENTRAL REGION
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Zip | 12746
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Country | SA
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Telephone | 00966114355555
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Fax |
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Provider Business Mailing Address
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Address Line | P.O.BOX 93098
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City | RIYADH
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State | CENTRAL REGION
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Zip | 11673
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Country | SA
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Telephone | 00966500003705
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 06-R-D-23338
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License Number State | ZZ
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