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General NPI Number Information
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NPI Number | 1922386473
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Entity Type | Individual
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Provider Name | NEEHAL GAMAL GHONIEM D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 838 NORDAHL RD STE 145
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City | SAN MARCOS
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State | CA
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Zip | 92069-3513
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Country | US
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Telephone | 760-480-6700
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Fax | 760-480-6701
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Provider Business Mailing Address
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Address Line | 4604 TERRAZA MAR MARVELOSA
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City | SAN DIEGO
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State | CA
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Zip | 92130-4675
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Country | US
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Telephone | 954-288-6696
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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 | 2901021180
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 61725
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License Number State | CA
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