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General NPI Number Information
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NPI Number | 1912689852
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Entity Type | Individual
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Provider Name | REYAN ABDELMONIEM
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Gender | Female
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 2050 BARB ST
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City | SILVERDALE
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State | WA
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Zip | 98315-2050
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Country | US
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Telephone | 360-315-4391
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 N ELSTON AVE APT 573
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City | CHICAGO
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State | IL
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Zip | 60614-0050
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Country | US
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Telephone | 301-281-5655
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 13472620-9922
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License Number State | UT
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